Healthcare Provider Details

I. General information

NPI: 1497570501
Provider Name (Legal Business Name): LUCRETIA NICOLE PERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCRETIA NICOLE QUINN

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

IV. Provider business mailing address

9709 KEY WEST AVE APT 205
ROCKVILLE MD
20850-4501
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-0016
  • Fax:
Mailing address:
  • Phone: 410-999-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1054938
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: