Healthcare Provider Details

I. General information

NPI: 1639919137
Provider Name (Legal Business Name): SERENA MAUREEN ALLISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SERENA MAUREEN HECKLER RN

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 LAPORTE AVE
VALPARAISO IN
46383-6914
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-4167
  • Fax: 219-462-0426
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28197925A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015538A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: