Provider Demographics
NPI:1558803205
Name:BREWER, SERENA (ARPN-CNP)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:ARPN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6888 E W 133 RD
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848
Mailing Address - Country:US
Mailing Address - Phone:405-379-6400
Mailing Address - Fax:
Practice Address - Street 1:6888 E 133 RD
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-9020
Practice Address - Country:US
Practice Address - Phone:405-379-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0057585163WE0003X
OKF1016688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency