Healthcare Provider Details

I. General information

NPI: 1972313864
Provider Name (Legal Business Name): CEDRIC H.F SOSSOU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE
LANSING MI
48912-1805
US

IV. Provider business mailing address

1140 E MICHIGAN AVE STE 400
LANSING MI
48912-1806
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704341866
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: