Healthcare Provider Details

I. General information

NPI: 1992821755
Provider Name (Legal Business Name): PATRICIA R PERRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 N WEBB RD
GRAND ISLAND NE
68803-1743
US

IV. Provider business mailing address

3520 AVENUE I
KEARNEY NE
68847-3213
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-7625
  • Fax: 308-384-8904
Mailing address:
  • Phone: 308-234-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number110556
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: