MEDICARE: SILVIA LOPEZ SERRANO MSN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	12264339-4405	UT

General Provider Information

NPI Number	:	1417831116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA LOPEZ SERRANO MSN, PMHNP

Provider Business Mailing Address
First Line	:	1133 N MAIN ST STE 100
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4868
Country	:	US
Telephone Number	:	503-925-3095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 N MAIN ST STE 100
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4868
Country	:	US
Telephone Number	:	503-925-3095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	03/16/2026

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