Healthcare Provider Details

I. General information

NPI: 1235409046
Provider Name (Legal Business Name): ANDREA DELOIS PERRY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 FOOTE PARK LN APT 102 1522 GENESIS CIR. #202
MEMPHIS TN
38126-3264
US

IV. Provider business mailing address

475 FOOTE PARK LN APT 102 1522 GENESIS CIR. #202
MEMPHIS TN
38126-3264
US

V. Phone/Fax

Practice location:
  • Phone: 901-503-3405
  • Fax:
Mailing address:
  • Phone: 901-503-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number111004657
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: