Provider Demographics
NPI:1639919137
Name:ALLISON, SERENA MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:MAUREEN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:MAUREEN
Other - Last Name:HECKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2421 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6914
Practice Address - Country:US
Practice Address - Phone:219-462-4167
Practice Address - Fax:219-462-0426
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28197925A163WG0000X
IN71015538A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice