Healthcare Provider Details

I. General information

NPI: 1205851490
Provider Name (Legal Business Name): MARILYN J PERKOWSKI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 WALES AVE NW SUITE 130
MASSILLON OH
44646
US

IV. Provider business mailing address

2037 WALES AVE NW SUITE 130
MASSILLON OH
44646
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-9378
  • Fax: 330-830-1534
Mailing address:
  • Phone: 330-830-9378
  • Fax: 330-830-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN135276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: