Provider Demographics
NPI:1669008728
Name:REBELLO, SEAN ANDREW (APRN CNP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANDREW
Last Name:REBELLO
Suffix:
Gender:M
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SMITHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4236
Mailing Address - Country:US
Mailing Address - Phone:401-477-3168
Mailing Address - Fax:
Practice Address - Street 1:180 CORLISS ST STE E
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2602
Practice Address - Country:US
Practice Address - Phone:401-793-2928
Practice Address - Fax:401-793-7401
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily