Provider Demographics
NPI:1053088914
Name:FRICKE, SEAN POWERS (RN, CCRN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:POWERS
Last Name:FRICKE
Suffix:
Gender:M
Credentials:RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5325
Mailing Address - Country:US
Mailing Address - Phone:802-793-2925
Mailing Address - Fax:
Practice Address - Street 1:3904 KELLY DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5325
Practice Address - Country:US
Practice Address - Phone:802-793-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9473239163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine