Provider Demographics
NPI:1174024327
Name:PENN, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:TULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6915 LAKEWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3299
Mailing Address - Country:US
Mailing Address - Phone:253-474-4226
Mailing Address - Fax:
Practice Address - Street 1:6915 LAKEWOOD DR W STE A2
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3299
Practice Address - Country:US
Practice Address - Phone:253-474-4226
Practice Address - Fax:253-474-9040
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA038.013198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor