Provider Demographics
NPI:1023843612
Name:SOSAN, NICK
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:SOSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 MUSTANG BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5804
Mailing Address - Country:US
Mailing Address - Phone:201-406-2396
Mailing Address - Fax:
Practice Address - Street 1:2022 MUSTANG BLUFF LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5804
Practice Address - Country:US
Practice Address - Phone:201-406-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171400000XOther Service ProvidersHealth & Wellness Coach