Healthcare Provider Details

I. General information

NPI: 1750581799
Provider Name (Legal Business Name): NICOLE SESSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 2ND ST
EUREKA CA
95501-0811
US

IV. Provider business mailing address

1657 LINCOLN ST
EUREKA CA
95501-1521
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-9590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: