Healthcare Provider Details

I. General information

NPI: 1952577074
Provider Name (Legal Business Name): SEAN C SUNDERMANN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 21ST ST
SIOUX FALLS SD
57105-1016
US

IV. Provider business mailing address

PO BOX 5045 ATTN: P.F.S.
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-2754
  • Fax: 605-322-2727
Mailing address:
  • Phone: 605-322-2754
  • Fax: 605-322-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberSD-CRNA CR000696
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: