Provider Demographics
NPI:1902411721
Name:DEITER, SEAN ARTHUR (CRNP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ARTHUR
Last Name:DEITER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 GYPSY LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1612
Mailing Address - Country:US
Mailing Address - Phone:215-510-8514
Mailing Address - Fax:
Practice Address - Street 1:3619 GYPSY LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1612
Practice Address - Country:US
Practice Address - Phone:215-510-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021952363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care