Healthcare Provider Details

I. General information

NPI: 1780556233
Provider Name (Legal Business Name): SERE PATH WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 COON RAPIDS BLVD NW STE 414
COON RAPIDS MN
55433-5865
US

IV. Provider business mailing address

277 COON RAPIDS BLVD NW STE 414
COON RAPIDS MN
55433-5865
US

V. Phone/Fax

Practice location:
  • Phone: 612-447-4747
  • Fax: 612-688-7880
Mailing address:
  • Phone: 612-447-4747
  • Fax: 612-688-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: YASHMIN NAGUJJA
Title or Position: OWNER
Credential: APRN PMHNP-BC
Phone: 612-447-4747