Individual
SERENA FAITH EAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
410 7TH AVE S, DEVILS LAKE, ND 58301
(701) 230-3726
Mailing address
410 7TH AVE SE, DEVILS LAKE, ND 58301-3700
(701) 230-3726
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
3747P1801X
Personal Care Attendant
—
ND
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780440968
QSP
ND
Enumeration date
02/26/2024
Last updated
04/19/2024
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