Healthcare Provider Details

I. General information

NPI: 1447702139
Provider Name (Legal Business Name): SERENE SPIRIT MENTAL HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ELTON HILLS DR NW STE 201
ROCHESTER MN
55901-2988
US

IV. Provider business mailing address

382 NORSEMAN CT NW
ROCHESTER MN
55901-2430
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-6564
  • Fax: 507-322-6566
Mailing address:
  • Phone: 507-254-5208
  • Fax: 507-322-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS0482
License Number StateMN

VIII. Authorized Official

Name: MS. DALE ANN NASBY
Title or Position: OWNER/CLINICAL NURSE SPECIALIST
Credential: PMHCNS-BC
Phone: 507-322-6564