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General NPI Number Information
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NPI Number | 1134674229
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE SERRANO LPN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE ATTN: MCHJ-CLQ-C
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City | TACOMA
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State | WA
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Zip | 98431-1100
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Country | US
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Telephone | 253-376-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 1723 201ST STREET CT E
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City | SPANAWAY
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State | WA
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Zip | 98387-8154
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Country | US
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Telephone | 253-376-8975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP60538065
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License Number State | WA
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