MEDICARE: KESANI ESSENTIALS WELLNESS AND AESTHETICS MEDSPA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1477379436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KESANI ESSENTIALS WELLNESS AND AESTHETICS MEDSPA PLLC

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY STE 301A
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-215-7957
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY STE 301A
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1846
Country	:	US
Telephone Number	:	703-215-7957
Fax Number	:

Authorized Official
Title or Position	:	CEO/NP
Name	:	MS. NICOLE DEASE
Credential	:	NP
Telephone Number	:	571-572-2303

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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