MEDICARE: SERENA MUNOZ APRN

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	363L00000X	Nurse Practitioner	210338	OK

General Provider Information

NPI Number	:	1801480017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA MUNOZ APRN

Provider Business Mailing Address
First Line	:	4623 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8975
Country	:	US
Telephone Number	:	918-221-6909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 W KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-8975
Country	:	US
Telephone Number	:	918-221-6909
Fax Number	:

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

Provider Enumeration Date	:	02/28/2021
Last Update Date	:	01/08/2025

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