Healthcare Provider Details

I. General information

NPI: 1043138787
Provider Name (Legal Business Name): SERENA VIGIL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 BIRCH PLZ APT 7
OMAHA NE
68164-2744
US

IV. Provider business mailing address

15418 WEIR ST # 317
OMAHA NE
68137-5045
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-6194
  • Fax:
Mailing address:
  • Phone: 402-614-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: