Healthcare Provider Details

I. General information

NPI: 1700908290
Provider Name (Legal Business Name): SEAN MICHAEL MCINERNEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-4220
  • Fax: 989-583-4287
Mailing address:
  • Phone: 989-583-2833
  • Fax: 989-583-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704229253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: