Provider Demographics
NPI:1053169425
Name:SERAN, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:SERAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 SPARKS BLVD APT 242
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-7945
Mailing Address - Country:US
Mailing Address - Phone:775-453-3849
Mailing Address - Fax:
Practice Address - Street 1:565 SPARKS BLVD APT 242
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-7945
Practice Address - Country:US
Practice Address - Phone:775-453-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant