Provider Demographics
NPI:1699357798
Name:SERKLAND, AMY KATHLEEN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:SERKLAND
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 S MCCLINTOCK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5879
Mailing Address - Country:US
Mailing Address - Phone:520-233-7111
Mailing Address - Fax:602-357-4604
Practice Address - Street 1:14395 W VOLTAIRE ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-6192
Practice Address - Country:US
Practice Address - Phone:520-233-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN092855163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management