Healthcare Provider Details

I. General information

NPI: 1770923195
Provider Name (Legal Business Name): ALISA YVETTE SESSOMS RD, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 VESTAL ST
GREENSBORO NC
27406-5116
US

IV. Provider business mailing address

2604 VESTAL ST
GREENSBORO NC
27406-5116
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-6693
  • Fax:
Mailing address:
  • Phone: 336-273-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL000036
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: