MEDICARE: VICKI S PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	91200	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000852	OTHER		KAISER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1053450452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI S PERRY

Provider Business Mailing Address
First Line	:	4803 WARD ROAD
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033
Country	:	US
Telephone Number	:	303-421-5061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 S HAVANA ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1618
Country	:	US
Telephone Number	:	303-421-5061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/12/2007

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Directions to “ VICKI S PERRY ” Practice Location

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