Healthcare Provider Details

I. General information

NPI: 1801360664
Provider Name (Legal Business Name): SEAN THOMPSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MILES RD
WEST CHESTER PA
19380-1950
US

IV. Provider business mailing address

760 MILES RD
WEST CHESTER PA
19380-1950
US

V. Phone/Fax

Practice location:
  • Phone: 610-429-3477
  • Fax:
Mailing address:
  • Phone: 610-429-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019916
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: