Healthcare Provider Details

I. General information

NPI: 1477425635
Provider Name (Legal Business Name): HOLLY LYNN SERNULKA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

7515 RISING EAGLE CT
GLEN BURNIE MD
21060-7594
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-3279
  • Fax:
Mailing address:
  • Phone: 443-537-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR241667
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: