Provider Demographics
NPI:1710872007
Name:VON SOSSAN, EVA MARIE
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:VON SOSSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:FORT JENNINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45844-0112
Mailing Address - Country:US
Mailing Address - Phone:419-203-5782
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 112
Practice Address - Street 2:
Practice Address - City:FORT JENNINGS
Practice Address - State:OH
Practice Address - Zip Code:45844-0112
Practice Address - Country:US
Practice Address - Phone:419-203-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty