Healthcare Provider Details

I. General information

NPI: 1518062322
Provider Name (Legal Business Name): JULIE L SERRES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GEARY STREET SE
ALBANY OR
97322-6842
US

IV. Provider business mailing address

1700 GEARY STREET SE
ALBANY OR
97322-6842
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-5655
  • Fax: 541-812-5699
Mailing address:
  • Phone: 541-812-5655
  • Fax: 541-812-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200650070NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: