Healthcare Provider Details

I. General information

NPI: 1912518853
Provider Name (Legal Business Name): SERENE LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N MCCORMICK ST STE 103
PRESCOTT AZ
86301-2725
US

IV. Provider business mailing address

143 N MCCORMICK ST STE 103
PRESCOTT AZ
86301-2725
US

V. Phone/Fax

Practice location:
  • Phone: 928-362-0268
  • Fax: 928-421-3182
Mailing address:
  • Phone: 928-362-0268
  • Fax: 928-421-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: INGE GISELA BUNDCHEN
Title or Position: PRESIDENT
Credential: NP
Phone: 928-362-0268