Healthcare Provider Details

I. General information

NPI: 1790580389
Provider Name (Legal Business Name): SAMANTHA RENEE SOSA WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 ELON RD
MADISON HEIGHTS VA
24572-2536
US

IV. Provider business mailing address

1008 DUNWICH DR
LIBERTY MO
64068-3038
US

V. Phone/Fax

Practice location:
  • Phone: 434-929-1400
  • Fax:
Mailing address:
  • Phone: 816-778-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2024040623
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024192941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: