Provider Demographics
NPI:1083215388
Name:WHITRIDGE, SERENA (DSOM, LAC, MSCN)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:WHITRIDGE
Suffix:
Gender:F
Credentials:DSOM, LAC, MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:HUSUM
Mailing Address - State:WA
Mailing Address - Zip Code:98623-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 NE TOHOMISH STREET SUITE 200
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98623-9862
Practice Address - Country:US
Practice Address - Phone:203-536-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC201586171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist