Healthcare Provider Details

I. General information

NPI: 1033943956
Provider Name (Legal Business Name): NIKKI SESE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DEBARR CIR
ANCHORAGE AK
99508-2984
US

IV. Provider business mailing address

19113 SARICHEF LOOP
EAGLE RIVER AK
99577-8631
US

V. Phone/Fax

Practice location:
  • Phone: 907-258-7575
  • Fax:
Mailing address:
  • Phone: 910-885-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number360395
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number214214
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: