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General NPI Number Information
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NPI Number | 1932744091
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Entity Type | Individual
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Provider Name | SEAN S VANDERWAAL
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Gender | Male
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2006 HOGBACK RD STE 5A
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City | ANN ARBOR
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State | MI
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Zip | 48105-9750
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Country | US
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Telephone | 734-263-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-874-4806
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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 | 4704327749
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License Number State | MI
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