Healthcare Provider Details

I. General information

NPI: 1568992519
Provider Name (Legal Business Name): SEIN GWON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 N CRAYCROFT RD
TUCSON AZ
85712-2243
US

IV. Provider business mailing address

2715 N 3RD ST
PHOENIX AZ
85004-1106
US

V. Phone/Fax

Practice location:
  • Phone: 520-322-2888
  • Fax:
Mailing address:
  • Phone: 602-264-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP10164
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: