MEDICARE: MR. SEAN L'HUILLIER SR. FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	TAP8194	AZ

General Provider Information

NPI Number	:	1326418526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN L'HUILLIER SR. FNP-C

Provider Business Mailing Address
First Line	:	1510 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-5173
Country	:	US
Telephone Number	:	928-753-1177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 N STOCKTON HILL RD
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-5173
Country	:	US
Telephone Number	:	928-753-1177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	02/01/2016

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