Provider Demographics
NPI:1336821479
Name:DRAKE, SERINA L
Entity Type:Individual
Prefix:
First Name:SERINA
Middle Name:L
Last Name:DRAKE
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 1:1824 LAMPWICK PL APT 13
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1833
Mailing Address - Country:US
Mailing Address - Phone:567-322-4736
Mailing Address - Fax:
Practice Address - Street 1:1824 LAMPWICK PL APT 13
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1833
Practice Address - Country:US
Practice Address - Phone:567-322-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker