Provider Demographics
NPI:1477209674
Name:HEEREN, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:HEEREN
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 1:3501 SAN ANDRES AVE NE APT B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4567
Mailing Address - Country:US
Mailing Address - Phone:505-387-9367
Mailing Address - Fax:
Practice Address - Street 1:3501 SAN ANDRES AVE NE APT B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4567
Practice Address - Country:US
Practice Address - Phone:505-387-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist