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NPI Code Detail

MEDICARE: SEIN GWON APNP

MEDICARE:   SEIN  GWON  APNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP10164AZ

General Provider Information

NPI Number : 1568992519
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEIN GWON APNP
Provider Business Mailing Address
First Line : 2715 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1106
Country : US
Telephone Number : 602-264-4331
Fax Number :
Provider Business Practice Location Address
First Line : 2695 N CRAYCROFT RD
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2243
Country : US
Telephone Number : 520-322-2888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2017
Last Update Date : 07/21/2021

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