Healthcare Provider Details

I. General information

NPI: 1780796268
Provider Name (Legal Business Name): DEDRA SERAFIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10046 N METRO PKWY W
PHOENIX AZ
85051-1437
US

IV. Provider business mailing address

10046 N METRO PKWY W
PHOENIX AZ
85051-1437
US

V. Phone/Fax

Practice location:
  • Phone: 844-646-3247
  • Fax: 602-364-0890
Mailing address:
  • Phone: 844-646-3247
  • Fax: 602-364-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-119463
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-18685
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: