Provider Demographics
NPI:1255165080
Name:SERNA, LAURA EVANS (CLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EVANS
Last Name:SERNA
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8716 GREENARBOR RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2614
Mailing Address - Country:US
Mailing Address - Phone:334-220-3233
Mailing Address - Fax:
Practice Address - Street 1:8716 GREENARBOR RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2614
Practice Address - Country:US
Practice Address - Phone:334-220-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN