MEDICARE: ANGELINA GABRIELLE PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1700689122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINA GABRIELLE PERRY

Provider Business Mailing Address
First Line	:	1411 N 70TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-1042
Country	:	US
Telephone Number	:	402-594-9738
Fax Number	:

Provider Business Practice Location Address
First Line	:	5480 N 90TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1804
Country	:	US
Telephone Number	:	531-215-6288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ ANGELINA GABRIELLE PERRY ” Practice Location

Language	Start Address	Practice Location

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