Provider Demographics
NPI:1790308641
Name:SERETI, LUCY KERUBO II (LVN)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:KERUBO
Last Name:SERETI
Suffix:II
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 RUFE SNOW DR APT 121
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8578
Mailing Address - Country:US
Mailing Address - Phone:214-960-6589
Mailing Address - Fax:
Practice Address - Street 1:4285 RUFE SNOW DR APT 121
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8578
Practice Address - Country:US
Practice Address - Phone:214-960-6589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351952164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse