MEDICARE: MRS. KEISHA YVETTE PERRY RN

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	163WH0200X	Home Health Registered Nurse	RN 304231	OH

General Provider Information

NPI Number	:	1144467986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEISHA YVETTE PERRY RN

Provider Business Mailing Address
First Line	:	5968 RED OAK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1841
Country	:	US
Telephone Number	:	567-455-6756
Fax Number	:

Provider Business Practice Location Address
First Line	:	5968 RED OAK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1841
Country	:	US
Telephone Number	:	567-455-6756
Fax Number	:

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

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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