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General NPI Number Information
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NPI Number | 1154896868
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Entity Type | Individual
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Provider Name | SEAN PAUL ELROD PMNP
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Gender | Male
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1500 NE IRVING ST STE 210
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City | PORTLAND
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State | OR
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Zip | 97232-2243
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Country | US
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Telephone | 425-477-4215
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE R
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City | PORTLAND
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State | OR
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Zip | 97239-3822
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Country | US
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Telephone |
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Fax | 623-738-3182
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP11821
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10017850
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License Number State | OR
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