Provider Demographics
NPI:1073377354
Name:PERRY, ANITA TATUM (LVN/LPN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:TATUM
Last Name:PERRY
Suffix:
Gender:F
Credentials:LVN/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 W 34TH ST STE B3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6661
Mailing Address - Country:US
Mailing Address - Phone:713-956-7712
Mailing Address - Fax:
Practice Address - Street 1:4800 W 34TH ST STE B3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6661
Practice Address - Country:US
Practice Address - Phone:713-956-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192645164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse