Provider Demographics
NPI:1023877917
Name:SERRANO, SHEYANNE LYNN
Entity type:Individual
Prefix:
First Name:SHEYANNE
Middle Name:LYNN
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 1:8603 BLANCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3903
Mailing Address - Country:US
Mailing Address - Phone:909-743-2060
Mailing Address - Fax:
Practice Address - Street 1:8603 BLANCHARD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3903
Practice Address - Country:US
Practice Address - Phone:909-743-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682773164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse