MEDICARE: MS. NANCY G SERABIAN R.N. C.S.

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	101YM0800X	Mental Health Counselor	RN26851	RI
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	APRN00572	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34827	OTHER	RI	BLUE CROSS

General Provider Information

NPI Number	:	1871639427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY G SERABIAN R.N. C.S.

Provider Business Mailing Address
First Line	:	1804 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-7648
Country	:	US
Telephone Number	:	401-954-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-7648
Country	:	US
Telephone Number	:	401-954-1962
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/20/2016

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