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General NPI Number Information
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NPI Number | 1922583475
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Entity Type | Individual
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Provider Name | SEAN MCLEAN CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 170 N 1100 E
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2096
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Country | US
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Telephone | 801-735-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 702 E 1170 N
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-9132
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Country | US
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Telephone | 801-735-8410
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 814877
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 6845598-4406
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License Number State | UT
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