MEDICARE: ASHLEY PEREZ 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	163WM0705X	Medical-Surgical Registered Nurse	786343	NY

General Provider Information

NPI Number	:	1932833696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY PEREZ RN

Provider Business Mailing Address
First Line	:	12 MCCREA ST
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1519
Country	:	US
Telephone Number	:	518-331-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 MCCREA ST
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1519
Country	:	US
Telephone Number	:	518-331-5165
Fax Number	:

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

Provider Enumeration Date	:	07/10/2022
Last Update Date	:	07/10/2022

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