Provider Demographics
NPI:1821343013
Name:TSOSIE, VIOLET
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:
Last Name:TSOSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC58 BOX 70 UNIT 178
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505
Mailing Address - Country:US
Mailing Address - Phone:928-890-9474
Mailing Address - Fax:
Practice Address - Street 1:HC 58 BOX 70
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-9708
Practice Address - Country:US
Practice Address - Phone:928-890-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ650556171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor