Provider Demographics
NPI:1376261545
Name:PONTOW, SEAN (LPN)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:PONTOW
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6934 WELLSFORD LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046-1430
Mailing Address - Country:US
Mailing Address - Phone:931-626-8423
Mailing Address - Fax:
Practice Address - Street 1:6934 WELLSFORD LN
Practice Address - Street 2:
Practice Address - City:COLLEGE GROVE
Practice Address - State:TN
Practice Address - Zip Code:37046-1430
Practice Address - Country:US
Practice Address - Phone:931-626-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver