Healthcare Provider Details

I. General information

NPI: 1316557101
Provider Name (Legal Business Name): SERENITY HEALTH CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 SUNSET DR UNIT B
MANDAN ND
58554-1547
US

IV. Provider business mailing address

2705 SUNSET DR UNIT B
MANDAN ND
58554-1547
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-1060
  • Fax:
Mailing address:
  • Phone: 701-751-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LEVEY
Title or Position: FNP/OWNER
Credential: FNP
Phone: 701-202-8789