Provider Demographics
NPI:1598130478
Name:HANDEL, SERENA (LMT)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:HANDEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SERENA
Other - Middle Name:
Other - Last Name:MOSTELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4425 SW CORBETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4260
Mailing Address - Country:US
Mailing Address - Phone:503-225-9033
Mailing Address - Fax:
Practice Address - Street 1:4425 SW CORBETT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4260
Practice Address - Country:US
Practice Address - Phone:503-225-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7626171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor