MEDICARE: SERENITY HEALTH & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1383	AK

General Provider Information

NPI Number	:	1639536394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	120 CARLANNA LAKE RD
Second Line	:	SUITE 102
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5611
Country	:	US
Telephone Number	:	907-247-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 CARLANNA LAKE RD
Second Line	:	SUITE 102
City	:	KETCHIKAN
State	:	AK
Zip	:	99901-5611
Country	:	US
Telephone Number	:	907-247-9355
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FNP
Name	:	TAMMY LORRAINE EARNEST
Credential	:	FNP-C
Telephone Number	:	907-617-5453

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

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