Provider Demographics
NPI:1689385536
Name:TRIPP, SEAN ANTHONY
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ANTHONY
Last Name:TRIPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 CENTRAL PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2651
Mailing Address - Country:US
Mailing Address - Phone:763-401-2447
Mailing Address - Fax:
Practice Address - Street 1:11901 CENTRAL PARK WAY
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-2651
Practice Address - Country:US
Practice Address - Phone:763-401-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN409986251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health