Provider Demographics
NPI:1679384689
Name:FETTERS, SEAN WILLIAM
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:WILLIAM
Last Name:FETTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:WILLIAM
Other - Last Name:FETTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8502 N NEVADA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7395
Mailing Address - Country:US
Mailing Address - Phone:509-464-4970
Mailing Address - Fax:509-464-4971
Practice Address - Street 1:8502 N NEVADA ST STE 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-464-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00142315163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health