Healthcare Provider Details

I. General information

NPI: 1922583475
Provider Name (Legal Business Name): SEAN MCLEAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N 1100 E
AMERICAN FORK UT
84003-2096
US

IV. Provider business mailing address

702 E 1170 N
PLEASANT GROVE UT
84062-9132
US

V. Phone/Fax

Practice location:
  • Phone: 801-735-8410
  • Fax:
Mailing address:
  • Phone: 801-735-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number814877
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6845598-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: