MEDICARE: NYSSAH DAWN PERRINE RN, FPMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	729871	TX

General Provider Information

NPI Number	:	1114226289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYSSAH DAWN PERRINE RN, FPMHNP-BC

Provider Business Mailing Address
First Line	:	424 S OAKES ST
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-5944
Country	:	US
Telephone Number	:	325-486-4500
Fax Number	:	325-486-2968

Provider Business Practice Location Address
First Line	:	424 S OAKES ST
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-5944
Country	:	US
Telephone Number	:	325-486-4500
Fax Number	:	325-486-2968

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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