Provider Demographics
NPI:1801130349
Name:SERNEKOS, LORETTA A (PHD, MSN, APN)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:A
Last Name:SERNEKOS
Suffix:
Gender:F
Credentials:PHD, MSN, APN
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:A
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1447
Mailing Address - Country:US
Mailing Address - Phone:609-561-2518
Mailing Address - Fax:609-567-0934
Practice Address - Street 1:111 VINE ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1447
Practice Address - Country:US
Practice Address - Phone:609-561-2518
Practice Address - Fax:609-567-0934
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00404500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health