Nelson Serrano

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

S650626012599 Issued in MI

Practice address

370 Country Club Rd Ste a
Holland, MI 49423-8303

Phone

(616) 393-2188

Fax

(616) 393-2182

NPI assigned

Jul 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Nelson Serrano Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1770192429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 COUNTRY CLUB RD STE A",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494238303",
            "telephone_number": "616-393-2188",
            "fax_number": "616-393-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 COUNTRY CLUB RD STE A",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494238303",
            "telephone_number": "616-393-2188",
            "fax_number": "616-393-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SERRANO",
        "first_name": "NELSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-29",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "MI",
            "license": "S650626012599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NELSON",
            "last_name": "SERRANO",
            "credential": "PEER RECOVERY COACH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Seppo Chiropractic
• Andrew Seppo, D.C.
• Caitlyn Seppo, D.C.
• Jeffrey Serdahely, DO
• Marissa Anabel Serrano
• Felicia Lynn Shabazz, LMSW
• Shaena Freeman, MD PLLC
• Priscilla Shafor, CPRM
• Kruti Shah, DDS
• Richard Shangle

• Peer Specialist in Holland, MI
• Providers in Holland, MI by specialty
• Peer Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.