Provider Demographics
NPI:1780611061
Name:SERNA, LAURA SUSANA (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUSANA
Last Name:SERNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 NE HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8925
Mailing Address - Country:US
Mailing Address - Phone:360-576-4140
Mailing Address - Fax:360-696-9049
Practice Address - Street 1:9102 NE HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8925
Practice Address - Country:US
Practice Address - Phone:360-576-4140
Practice Address - Fax:360-696-9049
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3005947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP95224Medicare UPIN