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General NPI Number Information
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NPI Number | 1649546813
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Entity Type | Individual
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Provider Name | SERENA THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 03/31/2012
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 2720 FAIRVIEW AVE N STE 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-1306
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Country | US
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Telephone | 651-241-5290
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 FAIRVIEW AVE N STE 100
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City | ROSEVILLE
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State | MN
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Zip | 55113-1306
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 62467
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 70036
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License Number State | MN
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