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NPI Code Detail

MEDICARE: SERENE PSYCHIATRIC SERVICES

MEDICARE: SERENE PSYCHIATRIC SERVICES
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1770300949
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERENE PSYCHIATRIC SERVICES
Provider Business Mailing Address
First Line : 4253 46TH AVE N APT 305
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-1354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 621 W LAKE ST STE 350
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2952
Country : US
Telephone Number : 612-979-2276
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : AKENZUA AGBATOR
Credential : CNP, PMHNP
Telephone Number : 651-216-3339
Provider Enumeration Date : 09/20/2024
Last Update Date : 05/20/2026

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Directions to “SERENE PSYCHIATRIC SERVICES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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