Provider Demographics
NPI:1376366815
Name:SOTO, SONIA KASSANDRA (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:KASSANDRA
Last Name:SOTO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 HALLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2730
Mailing Address - Country:US
Mailing Address - Phone:920-728-4308
Mailing Address - Fax:
Practice Address - Street 1:4402 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2590
Practice Address - Country:US
Practice Address - Phone:586-200-0611
Practice Address - Fax:586-381-7055
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704357441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner