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General NPI Number Information
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NPI Number | 1134918550
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Entity Type | Organization
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Legal Business Name | SERENE MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 4470 W 78TH STREET CIR STE 265
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5408
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Country | US
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Telephone | 952-260-3367
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Fax | 952-213-4260
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Provider Business Mailing Address
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Address Line | 4470 W 78TH STREET CIR STE 265
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5408
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Country | US
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Telephone | 952-260-3367
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Fax | 952-213-4260
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | FARTUN AHMED KEYNAN
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Credential | APRN, FNP, PMHNP
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Telephone | 952-260-3367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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