Healthcare Provider Details

I. General information

NPI: 1548002868
Provider Name (Legal Business Name): SEAN MICHAEL CHESTER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

3910 E TANGLEWOOD DR
PHOENIX AZ
85048-7349
US

V. Phone/Fax

Practice location:
  • Phone: 480-221-1705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95163099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: