Provider Demographics
NPI:1780796268
Name:SERAFIN, DEDRA (RN)
Entity type:Individual
Prefix:
First Name:DEDRA
Middle Name:
Last Name:SERAFIN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10046 N METRO PKWY W
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1437
Mailing Address - Country:US
Mailing Address - Phone:844-646-3247
Mailing Address - Fax:602-364-0890
Practice Address - Street 1:10046 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1437
Practice Address - Country:US
Practice Address - Phone:844-646-3247
Practice Address - Fax:602-364-0890
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-119463163WP0808X
AZLPC-18685101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health