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General NPI Number Information
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NPI Number | 1689085466
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Entity Type | Organization
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Legal Business Name | SEAN HEARN MD LLC
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 5 METATE DR
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City | SANDIA PARK
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State | NM
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Zip | 87047-8508
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Country | US
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Telephone | 651-246-8126
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Fax |
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Provider Business Mailing Address
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Address Line | 5 METATE DR
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City | SANDIA PARK
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State | NM
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Zip | 87047-8508
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Country | US
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Telephone | 651-246-8126
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Fax |
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Authorized Official
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Title or Position | FAMILY MEDICINE/ PSYCHOANALYST
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Name | DR. SEAN TIMOTHY HEARN
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Credential | M.D.
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Telephone | 651-246-8126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 35931
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License Number State | MN
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