Provider Demographics
NPI:1134366008
Name:SOHOSKI, MARY DENISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:SOHOSKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 JIMMY JOHNSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6306
Mailing Address - Country:US
Mailing Address - Phone:409-982-0082
Mailing Address - Fax:
Practice Address - Street 1:3300 JIMMY JOHNSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6306
Practice Address - Country:US
Practice Address - Phone:409-982-0082
Practice Address - Fax:409-982-3641
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289726602Medicaid
TX289726601Medicaid