Provider Demographics
NPI:1952159899
Name:SERENITY PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOLINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PMHNP-BC, APNP
Authorized Official - Phone:920-315-3922
Mailing Address - Street 1:298 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4357
Mailing Address - Country:US
Mailing Address - Phone:920-315-3922
Mailing Address - Fax:920-214-1076
Practice Address - Street 1:298 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4357
Practice Address - Country:US
Practice Address - Phone:920-315-3922
Practice Address - Fax:920-214-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health