Provider Demographics
NPI:1750799938
Name:MEYER, SEAN ALAN (FNP-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ALAN
Last Name:MEYER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-4004
Mailing Address - Country:US
Mailing Address - Phone:208-449-8348
Mailing Address - Fax:
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9768
Practice Address - Country:US
Practice Address - Phone:775-783-0222
Practice Address - Fax:775-463-3016
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 1599 A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily