Healthcare Provider Details

I. General information

NPI: 1366762015
Provider Name (Legal Business Name): GERALYN SUE PERKINS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

IV. Provider business mailing address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-1854
  • Fax: 937-436-1459
Mailing address:
  • Phone: 937-436-1854
  • Fax: 937-436-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11516NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: