=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922052612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER J SOSNOWSKI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 04/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17787 N PERIMETER DR SUITE A115
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-588-7787
-----------------------------------------------------
Fax | 480-588-5121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17787 N PERIMETER DR SUITE A115
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-5454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-588-7787
-----------------------------------------------------
Fax | 480-588-5121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25789
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------