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General NPI Number Information
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NPI Number | 1154675387
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Entity Type | Individual
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Provider Name | ELIZABETH SERRA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 11/12/2012
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-745-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 JASON CIR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48306-3639
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4704276171
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License Number State | MI
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