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NPI Code Detail

MEDICARE: MR. SEAN PATRICK ENSIGN APRN, CRNA

MEDICARE: MR. SEAN PATRICK ENSIGN APRN, CRNA
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
1367500000XCertified Registered Nurse Anesthetist225882AZ

General Provider Information

NPI Number : 1710422928
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEAN PATRICK ENSIGN APRN, CRNA
Provider Business Mailing Address
First Line : 13400 E SHEA BLVD
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85259-5499
Country : US
Telephone Number : 480-301-8000
Fax Number :
Provider Business Practice Location Address
First Line : 5881 E MAYO BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85054-4504
Country : US
Telephone Number : 480-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2016
Last Update Date : 10/13/2020

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