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General NPI Number Information
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NPI Number | 1639536394
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Entity Type | Organization
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Legal Business Name | SERENITY HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 120 CARLANNA LAKE RD SUITE 102
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City | KETCHIKAN
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State | AK
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Zip | 99901-5611
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Country | US
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Telephone | 907-247-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CARLANNA LAKE RD SUITE 102
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City | KETCHIKAN
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State | AK
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Zip | 99901-5611
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Country | US
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Telephone | 907-247-9355
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Fax |
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Authorized Official
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Title or Position | OWNER/FNP
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Name | TAMMY LORRAINE EARNEST
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Credential | FNP-C
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Telephone | 907-617-5453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1383
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License Number State | AK
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