Healthcare Provider Details

I. General information

NPI: 1851563944
Provider Name (Legal Business Name): MS. MICHAELA A SESSUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 25 1/2 RD
GRAND JUNCTION CO
81505-6401
US

IV. Provider business mailing address

627 25 1/2 ROAD
GRAND JUNCTION CO
81505
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-3535
  • Fax: 970-242-0293
Mailing address:
  • Phone: 970-242-3535
  • Fax: 970-242-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: