Healthcare Provider Details

I. General information

NPI: 1689596124
Provider Name (Legal Business Name): SEAN THOMAS FLEMING CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 UNIVERSITY AVE NE
FRIDLEY MN
55432-4946
US

IV. Provider business mailing address

19079 GREENBROOK DR NE
EAST BETHEL MN
55092-9572
US

V. Phone/Fax

Practice location:
  • Phone: 763-586-5844
  • Fax:
Mailing address:
  • Phone: 507-213-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14501
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: