MEDICARE: MISS LANELLE PERRY RN, CNS, PHD

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	363L00000X	Nurse Practitioner	COA.06052	OH
2	163WC1500X	Community Health Registered Nurse	COA06052-NS	OH

General Provider Information

NPI Number	:	1144666066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LANELLE PERRY RN, CNS, PHD

Provider Business Mailing Address
First Line	:	3089 BECKET RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2709
Country	:	US
Telephone Number	:	216-374-8040
Fax Number	:	216-921-1455

Provider Business Practice Location Address
First Line	:	3089 BECKET RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2709
Country	:	US
Telephone Number	:	216-374-8040
Fax Number	:	216-921-1455

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

Provider Enumeration Date	:	05/18/2013
Last Update Date	:	01/29/2019

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