Basic Information
| Provider Information | |||||||||
| NPI: | 1134510357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERDULA | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4380 MALSBARY RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137936444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2040 US HIGHWAY 50 | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451038694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137327015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN.148798-M-IV | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.