Healthcare Provider Details

I. General information

NPI: 1962547729
Provider Name (Legal Business Name): SERENA M. BARCHA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 97TH AVE SE
LAKE STEVENS WA
98258-3910
US

IV. Provider business mailing address

619 97TH AVE SE
LAKE STEVENS WA
98258-3910
US

V. Phone/Fax

Practice location:
  • Phone: 425-232-8854
  • Fax: 425-335-4328
Mailing address:
  • Phone: 425-232-8854
  • Fax: 425-335-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberMA00006941
License Number StateWA

VIII. Authorized Official

Name: MS. SERENA MAE BARCHA
Title or Position: PRES.
Credential: LMP
Phone: 425-232-8854