Provider Demographics
NPI:1750829784
Name:SOSSOMAN, EMILY ANN (NP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:SOSSOMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32652 KNO
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-9805
Mailing Address - Country:US
Mailing Address - Phone:269-782-4141
Mailing Address - Fax:
Practice Address - Street 1:32652 KNO
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-9805
Practice Address - Country:US
Practice Address - Phone:269-782-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily