Healthcare Provider Details

I. General information

NPI: 1083601918
Provider Name (Legal Business Name): AUDREY JOYCE PERRY C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOPE DRIVE SUITES 202 & 204
HERSHEY PA
17033-2086
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-3503
  • Fax: 717-531-4375
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberMW010043
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW010043
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: