Provider Demographics
NPI:1689164261
Name:SESAY, MAMUSU (LPN)
Entity Type:Individual
Prefix:
First Name:MAMUSU
Middle Name:
Last Name:SESAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WARREN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4480
Mailing Address - Country:US
Mailing Address - Phone:804-588-9178
Mailing Address - Fax:571-441-0861
Practice Address - Street 1:116 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3337
Practice Address - Country:US
Practice Address - Phone:800-601-0790
Practice Address - Fax:571-441-0861
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP48908164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427550110Medicaid