Healthcare Provider Details

I. General information

NPI: 1730750423
Provider Name (Legal Business Name): SERENE MOTHERHOOD SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 S 80TH ST
WEST ALLIS WI
53219-1722
US

IV. Provider business mailing address

3421 W VLIET ST UNIT 80223
MILWAUKEE WI
53208-4932
US

V. Phone/Fax

Practice location:
  • Phone: 414-231-1715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARIBEL RODRIGUEZ
Title or Position: CO-FOUNDER
Credential:
Phone: 414-213-7789