Provider Demographics
NPI:1982907564
Name:SERRANO, KIMBERLY DOLORES (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DOLORES
Last Name:SERRANO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3840
Mailing Address - Country:US
Mailing Address - Phone:708-369-6332
Mailing Address - Fax:
Practice Address - Street 1:800 BROADVIEW VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-4887
Practice Address - Country:US
Practice Address - Phone:708-731-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner