Provider Demographics
NPI:1932701406
Name:SERINEO, MARLIJO SHEA
Entity Type:Individual
Prefix:
First Name:MARLIJO
Middle Name:SHEA
Last Name:SERINEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 SE HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8343
Mailing Address - Country:US
Mailing Address - Phone:808-825-8110
Mailing Address - Fax:
Practice Address - Street 1:1622 SE HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8343
Practice Address - Country:US
Practice Address - Phone:808-825-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator