Healthcare Provider Details

I. General information

NPI: 1427791367
Provider Name (Legal Business Name): SEAN ONO GILL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5689 GRANTHAM LN
DUBLIN OH
43016-3260
US

IV. Provider business mailing address

5689 GRANTHAM LN
DUBLIN OH
43016-3260
US

V. Phone/Fax

Practice location:
  • Phone: 614-578-6017
  • Fax:
Mailing address:
  • Phone: 614-578-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.485518
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031590
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: