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General NPI Number Information
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NPI Number | 1790507366
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Entity Type | Organization
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Legal Business Name | SERENE INFUSION AND WELLNESS LOUNGE LLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 40W222 LAFOX RD STE P2-E
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City | ST CHARLES
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State | IL
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Zip | 60175-7625
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Country | US
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Telephone | 630-402-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 PRAIRIE CROSSING DR # A
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City | MONTGOMERY
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State | IL
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Zip | 60538-4057
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Country | US
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Telephone | 312-646-8086
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Fax | 630-402-6683
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Authorized Official
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Title or Position | CEO
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Name | YEWANDE BANIRE
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Credential | FNP
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Telephone | 630-402-6627
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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 |
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License Number State |
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