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Individual
MARA MARIE VAN FOSSEN
Active
Individual
MARA MARIE VAN FOSSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
113947
WV
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.0031865
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000385
—
OH
05
—
1265169627
—
WV
Enumeration date
08/05/2022
Last updated
09/04/2026
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