Healthcare Provider Details

I. General information

NPI: 1043943327
Provider Name (Legal Business Name): LISETTE SERRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date: 08/10/2023
Reactivation Date: 01/29/2024

III. Provider practice location address

1500 W MAIN ST
SUN PRAIRIE WI
53590-1812
US

IV. Provider business mailing address

1500 W MAIN ST
SUN PRAIRIE WI
53590-1812
US

V. Phone/Fax

Practice location:
  • Phone: 608-453-7879
  • Fax: 608-453-7878
Mailing address:
  • Phone: 608-453-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: