Provider Demographics
NPI:1992800916
Name:SESERA, RUTH SHIRLEY (NP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:SHIRLEY
Last Name:SESERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10052 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8574
Mailing Address - Country:US
Mailing Address - Phone:251-621-8485
Mailing Address - Fax:
Practice Address - Street 1:5912 OLD MOBILE HIGHWAY
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581
Practice Address - Country:US
Practice Address - Phone:228-762-4642
Practice Address - Fax:228-207-3087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090086363LF0000X
MSR879202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5153395SESMedicare PIN
ALQ68801Medicare UPIN