Provider Demographics
NPI:1972802759
Name:SERNA, SABRINA ELIZABETH (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:ELIZABETH
Last Name:SERNA
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 MILL WATER XING
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4184
Mailing Address - Country:US
Mailing Address - Phone:770-310-9299
Mailing Address - Fax:
Practice Address - Street 1:4654 MILL WATER XING
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4184
Practice Address - Country:US
Practice Address - Phone:770-310-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10912095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist