Healthcare Provider Details

I. General information

NPI: 1164255733
Provider Name (Legal Business Name): APEX SERENITY CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 PAYNE AVE STE B2
SAINT PAUL MN
55130-4280
US

IV. Provider business mailing address

925 PAYNE AVE STE B2
SAINT PAUL MN
55130-4280
US

V. Phone/Fax

Practice location:
  • Phone: 763-913-8125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRINCESS GEHYIGON WALLACE
Title or Position: OWNER
Credential: DNP, APRN, CNP
Phone: 763-913-8125