Healthcare Provider Details

I. General information

NPI: 1154846137
Provider Name (Legal Business Name): CARRIE KURZ SERWATKA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 3RD ST STE 210
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

20 S 3RD ST STE 210
COLUMBUS OH
43215-4206
US

V. Phone/Fax

Practice location:
  • Phone: 440-409-7935
  • Fax:
Mailing address:
  • Phone: 440-409-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.021502
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.021502
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: