1730036401 NPI number — MRS. ELVIRA MARIA SERRATO JULY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730036401 NPI number — MRS. ELVIRA MARIA SERRATO JULY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRATO
Provider First Name:
ELVIRA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
JULY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANLEY
Provider Other First Name:
ELVIRA
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730036401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 PONDEROSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINATARE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-220-8601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 PONDEROSA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINATARE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-220-8601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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