Provider Demographics
NPI:1679156244
Name:NEMORIN, SEAN ALEXANDER
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ALEXANDER
Last Name:NEMORIN
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 1:3111 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-8127
Mailing Address - Country:US
Mailing Address - Phone:810-985-8900
Mailing Address - Fax:
Practice Address - Street 1:3615 MYRTLE RD
Practice Address - Street 2:
Practice Address - City:BURTCHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48059-2231
Practice Address - Country:US
Practice Address - Phone:810-887-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIN565762044162172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker