Provider Demographics
NPI:1477379436
Name:KESANI ESSENTIALS WELLNESS AND AESTHETICS MEDSPA PLLC
Entity type:Organization
Organization Name:KESANI ESSENTIALS WELLNESS AND AESTHETICS MEDSPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/NP
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEASE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:571-572-2303
Mailing Address - Street 1:6911 RICHMOND HWY STE 301A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1846
Mailing Address - Country:US
Mailing Address - Phone:703-215-7957
Mailing Address - Fax:
Practice Address - Street 1:6911 RICHMOND HWY STE 301A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1846
Practice Address - Country:US
Practice Address - Phone:703-215-7957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty