Provider Demographics
NPI:1114750403
Name:SERRANO, EDITH ANN
Entity type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:ANN
Last Name:SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-0747
Mailing Address - Country:US
Mailing Address - Phone:917-501-6982
Mailing Address - Fax:
Practice Address - Street 1:409 FRONT ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2699
Practice Address - Country:US
Practice Address - Phone:917-501-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide