Provider Demographics
NPI:1134918550
Name:SERENE MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:SERENE MEDICAL CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FARTUN
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:KEYNAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP, PMHNP
Authorized Official - Phone:612-501-4420
Mailing Address - Street 1:4470 W 78TH STREET CIR STE 265
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5408
Mailing Address - Country:US
Mailing Address - Phone:952-260-3367
Mailing Address - Fax:952-213-4260
Practice Address - Street 1:4470 W 78TH STREET CIR STE 265
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5408
Practice Address - Country:US
Practice Address - Phone:952-260-3367
Practice Address - Fax:952-213-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty