Provider Demographics
NPI:1790507366
Name:SERENE INFUSION AND WELLNESS LOUNGE LLC
Entity type:Organization
Organization Name:SERENE INFUSION AND WELLNESS LOUNGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YEWANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIRE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:630-402-6627
Mailing Address - Street 1:2436 PRAIRIE CROSSING DR # A
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4057
Mailing Address - Country:US
Mailing Address - Phone:312-646-8086
Mailing Address - Fax:630-402-6683
Practice Address - Street 1:40W222 LAFOX RD STE P2-E
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7625
Practice Address - Country:US
Practice Address - Phone:630-402-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty