Provider Demographics
NPI:1306113881
Name:MEYER, SERENA F (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:F
Last Name:MEYER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 MARTIS COURT
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803
Mailing Address - Country:US
Mailing Address - Phone:510-612-4000
Mailing Address - Fax:510-275-0331
Practice Address - Street 1:5425 MARTIS CT
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-3441
Practice Address - Country:US
Practice Address - Phone:510-612-4000
Practice Address - Fax:510-213-6680
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95048954163WL0100X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant