Healthcare Provider Details

I. General information

NPI: 1548150246
Provider Name (Legal Business Name): SCOTT SECKENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3913 LODGEPOLE LN
RALEIGH NC
27616-8844
US

IV. Provider business mailing address

3913 LODGEPOLE LN
RALEIGH NC
27616-8844
US

V. Phone/Fax

Practice location:
  • Phone: 443-624-1857
  • Fax:
Mailing address:
  • Phone: 443-624-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR245801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: