Healthcare Provider Details

I. General information

NPI: 1720886799
Provider Name (Legal Business Name): SERENA SUWARNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 VELVET HORN
LORAIN OH
44053-4354
US

IV. Provider business mailing address

6835 VELVET HORN
LORAIN OH
44053-4354
US

V. Phone/Fax

Practice location:
  • Phone: 216-789-4456
  • Fax:
Mailing address:
  • Phone: 216-789-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: