Healthcare Provider Details

I. General information

NPI: 1073318028
Provider Name (Legal Business Name): NICOLE LYNN SESSER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E WESTERN RESERVE RD
POLAND OH
44514-3358
US

IV. Provider business mailing address

715 E WESTERN RESERVE RD
POLAND OH
44514-3358
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3204
  • Fax: 330-729-9316
Mailing address:
  • Phone: 330-726-3204
  • Fax: 330-729-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0038715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: