Provider Demographics
NPI:1447865159
Name:SEBESKY, NICHOLE RENEE
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENEE
Last Name:SEBESKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PARK DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7685
Mailing Address - Country:US
Mailing Address - Phone:765-516-3549
Mailing Address - Fax:
Practice Address - Street 1:1125 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2140
Practice Address - Country:US
Practice Address - Phone:317-736-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28192022A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist