Healthcare Provider Details

I. General information

NPI: 1356287601
Provider Name (Legal Business Name): SERENA HULSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W CHERYL DR STE A150
PHOENIX AZ
85051-9615
US

IV. Provider business mailing address

24412 N 40TH AVE
GLENDALE AZ
85310-3271
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-6582
  • Fax:
Mailing address:
  • Phone: 928-699-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number338418
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: