MEDICARE: MS. IMAN SERENA DANIEL NURSE PRACTITIONER

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	163W00000X	Registered Nurse	28247425A	IN

General Provider Information

NPI Number	:	1619624830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IMAN SERENA DANIEL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6821 CREEK VALE WAY APT 2C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9497
Country	:	US
Telephone Number	:	563-508-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 CREEK VALE WAY APT 2C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9497
Country	:	US
Telephone Number	:	563-508-2699
Fax Number	:

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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