Healthcare Provider Details

I. General information

NPI: 1568837268
Provider Name (Legal Business Name): SEAN ROAN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071
APO AP
96328-5071
US

IV. Provider business mailing address

411 OAK ST. STERLING MEDICAL ASSOCIATES. ATTN: CREDENTIALS
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-2714
  • Fax:
Mailing address:
  • Phone: 513-984-1800
  • Fax: 513-984-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041404504
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: