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NPI Code Detail

MEDICARE: LYNISE PERRY CNS

MEDICARE: LYNISE PERRY CNS
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
1133NN1002XNutrition Education Nutritionist
2133N00000XNutritionistDX4713MD
3133N00000XNutritionist

General Provider Information

NPI Number : 1770065922
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNISE PERRY CNS
Provider Business Mailing Address
First Line : 557 RIVER CREEK RD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-6233
Country : US
Telephone Number : 234-564-3726
Fax Number :
Provider Business Practice Location Address
First Line : 638 INDEPENDENCE PKWY
Second Line : STE 240
City : CHESAPEAKE
State : VA
Zip : 23320-5222
Country : US
Telephone Number : 234-564-3726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/10/2019

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