Healthcare Provider Details

I. General information

NPI: 1205520871
Provider Name (Legal Business Name): NADEGE SESONGA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 PHILADELPHIA DR
DAYTON OH
45406-1814
US

IV. Provider business mailing address

2261 PHILADELPHIA DR
DAYTON OH
45406-1814
US

V. Phone/Fax

Practice location:
  • Phone: 937-430-9527
  • Fax:
Mailing address:
  • Phone: 937-430-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0033537
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033537
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: