Provider Demographics
NPI:1871639427
Name:SERABIAN, NANCY G (RN CS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:G
Last Name:SERABIAN
Suffix:
Gender:F
Credentials:RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-7648
Mailing Address - Country:US
Mailing Address - Phone:401-954-1962
Mailing Address - Fax:
Practice Address - Street 1:1804 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-7648
Practice Address - Country:US
Practice Address - Phone:401-954-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN26851101YM0800X
RIAPRN00572364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI34827OtherBLUE CROSS
RI899003482Medicare ID - Type Unspecified