Individual
SERENA WORMALD KOCOUREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
239287
SC
363LA2100X
Acute Care Nurse Practitioner
Primary
23689
SC
363LG0600X
Gerontology Nurse Practitioner
23689
SC
Other
Enumeration date
01/17/2020
Last updated
05/17/2021
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