Provider Demographics
NPI:1568233989
Name:SERENE LABS
Entity Type:Organization
Organization Name:SERENE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:APOLLONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:PBT
Authorized Official - Phone:217-870-1126
Mailing Address - Street 1:903 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1166
Mailing Address - Country:US
Mailing Address - Phone:217-870-1126
Mailing Address - Fax:
Practice Address - Street 1:903 N UNION ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1166
Practice Address - Country:US
Practice Address - Phone:217-870-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty