MEDICARE: CHEYENNE ALICIA SERRA FNP-BC

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	163WE0003X	Emergency Registered Nurse	750221	NY
2	363LF0000X	Family Nurse Practitioner	352301	NY

General Provider Information

NPI Number	:	1780254649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE ALICIA SERRA FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 COLUMBIA ST
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-2933
Country	:	US
Telephone Number	:	518-434-2526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/10/2023

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