Provider Demographics
NPI:1225397730
Name:SERWANO, PRISCILLA BUKIRWA
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:BUKIRWA
Last Name:SERWANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 AVENZA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3154
Mailing Address - Country:US
Mailing Address - Phone:702-716-8824
Mailing Address - Fax:
Practice Address - Street 1:61 AVENZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3154
Practice Address - Country:US
Practice Address - Phone:702-716-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner