Provider Demographics
NPI:1275955957
Name:SOSSAMON, WESLEY CHASE (CRNA)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:CHASE
Last Name:SOSSAMON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 N GILBERT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2109
Mailing Address - Country:US
Mailing Address - Phone:833-534-8273
Mailing Address - Fax:
Practice Address - Street 1:2248 N ALMA SCHOOL RD STE 104
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2488
Practice Address - Country:US
Practice Address - Phone:833-534-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR82917163W00000X
COC.APN.0100947-C-CRNA367500000X
ARC003028367500000X
AZ1403367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse