Individual provider Active NPI

Serah W Omariba

  • Registered Nurse
  • Rogers, MN
National Provider Identifier
1104703214
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
229733-2 Issued in MN
Practice address
20137 Goldeneye Way
Rogers, MN 55374-8975
Phone
(763) 439-5532
NPI assigned
Aug 19, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 229733-2 MN Primary

Addresses

Primary practice location

20137 Goldeneye Way
Rogers, MN 55374-8975

Mailing address

20137 Goldeneye Way
Rogers, MN 55374-8975
Phone (763) 439-5532

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
229733-2MNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Beyondlove Care LLC CurrentSince Aug 25, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1104703214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20137 GOLDENEYE WAY",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553748975",
            "telephone_number": "763-439-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20137 GOLDENEYE WAY",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553748975",
            "telephone_number": "763-439-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMARIBA",
        "first_name": "SERAH",
        "middle_name": "W",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-19",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "229733-2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.