Healthcare Provider Details

I. General information

NPI: 1184545253
Provider Name (Legal Business Name): SEAN MICHAEL MYHRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 WASHINGTON DR STE 110
EAGAN MN
55122-4301
US

IV. Provider business mailing address

431 BETTY LN
WEST ST PAUL MN
55118-2906
US

V. Phone/Fax

Practice location:
  • Phone: 651-283-6005
  • Fax:
Mailing address:
  • Phone: 651-283-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: