Provider Demographics
NPI:1053858712
Name:PERRY, WINZETTA
Entity Type:Individual
Prefix:
First Name:WINZETTA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3247
Mailing Address - Country:US
Mailing Address - Phone:402-639-1512
Mailing Address - Fax:402-614-1021
Practice Address - Street 1:2509 SPENCER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3247
Practice Address - Country:US
Practice Address - Phone:402-639-1512
Practice Address - Fax:402-614-1021
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
NEALF354374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility