MEDICARE: JOHNNA KAYE PERRY RN

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	163W00000X	Registered Nurse	392460	OH

General Provider Information

NPI Number	:	1831518307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNA KAYE PERRY RN

Provider Business Mailing Address
First Line	:	5065 RED MAPLE CT
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7084
Country	:	US
Telephone Number	:	832-623-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 ORCHARDVIEW RD
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-5841
Country	:	US
Telephone Number	:	832-623-9600
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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