Provider Demographics
NPI:1780556233
Name:SERE PATH WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SERE PATH WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASHMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGUJJA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN PMHNP-BC
Authorized Official - Phone:612-447-4747
Mailing Address - Street 1:277 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5843
Mailing Address - Country:US
Mailing Address - Phone:612-447-4747
Mailing Address - Fax:612-688-7880
Practice Address - Street 1:277 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5843
Practice Address - Country:US
Practice Address - Phone:612-447-4747
Practice Address - Fax:612-688-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty