Provider Demographics
NPI:1467198457
Name:IRMIERE, SERENA INDIGO (ATC)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:INDIGO
Last Name:IRMIERE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 16TH AVE APT 427
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1686
Mailing Address - Country:US
Mailing Address - Phone:973-768-4357
Mailing Address - Fax:
Practice Address - Street 1:2900 E 16TH AVE APT 427
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1686
Practice Address - Country:US
Practice Address - Phone:973-768-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2404207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine