Serina Johnson
Individual provider Active NPI Licensed Practical Nurse · Edgewood, NM
NPI 1295320489 · NPPES record last updated Mar 9, 2021
Key facts
- NPI
- 1295320489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- PN.0045666 (CO)
- Practice address
- 104 Quail Trail
Unit B
Edgewood, NM 87015 - Phone
- (505) 208-0204
- NPI assigned
- Mar 9, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN.0045666 | CO | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN.0045666 | CO | Yes |
Addresses
Primary practice location
104 Quail Trail
Unit B
Edgewood, NM 87015
Mailing address
104 Quail Trail
Unit B
Edgewood, NM 87015
Phone (505) 208-0204
Other providers in Edgewood, NM
- Yourah Hwang
- Brian R Ingram
- Dennis W. Jackson
- Melissa D Jackson
- Darcie Jepsen
- Paula A Jones-Irvin
- Joshua Jones
- Lisa Christine Kazmar
- Angela King
- Amanda M Krahenbuhl
All providers in Edgewood, NM · Licensed Practical Nurse in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.