Individual
DIANE L SERENSON-UNGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2885 W HOWARD NICKELL RD, FAYETTEVILLE, AR 72704-5459
(479) 409-5267
Mailing address
2885 W HOWARD NICKELL RD, FAYETTEVILLE, AR 72704-5459
(479) 409-5267
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
330652
NY
363L00000X
Nurse Practitioner
A001004
AR
363L00000X
Nurse Practitioner
Primary
A01004ANP
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136354758
—
AR
01
—
5T997
AR BC/BS
AR
Enumeration date
06/23/2006
Last updated
09/10/2020
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