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General NPI Number Information
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NPI Number | 1033622709
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Entity Type | Individual
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Provider Name | SEAN ROBERT HORNER PAC
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Gender | Male
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2102 E INWOOD RD
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City | SOUTH BEND
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State | IN
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Zip | 46614-2443
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Country | US
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Telephone | 574-299-2411
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Fax | 574-299-2410
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Provider Business Mailing Address
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Address Line | 51268 GILROY CT
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City | GRANGER
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State | IN
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Zip | 46530-4728
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Country | US
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Telephone | 585-734-3368
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Fax | 574-523-3221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002373A
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License Number State | IN
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