Provider Demographics
NPI:1639536394
Name:SERENITY HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:SERENITY HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:EARNEST
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:907-617-5453
Mailing Address - Street 1:120 CARLANNA LAKE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5611
Mailing Address - Country:US
Mailing Address - Phone:907-247-9355
Mailing Address - Fax:
Practice Address - Street 1:120 CARLANNA LAKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5611
Practice Address - Country:US
Practice Address - Phone:907-247-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty