Provider Demographics
NPI:1053389973
Name:KANE, SEAN M (ANP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:KANE
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14510 W SHUMWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5815
Mailing Address - Country:US
Mailing Address - Phone:623-975-1660
Mailing Address - Fax:623-584-4282
Practice Address - Street 1:14510 W SHUMWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5815
Practice Address - Country:US
Practice Address - Phone:623-975-1660
Practice Address - Fax:623-584-4282
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1494363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726747Medicaid