Provider Demographics
NPI:1134473002
Name:PERRY, JAMMIE DIANE
Entity Type:Individual
Prefix:MISS
First Name:JAMMIE
Middle Name:DIANE
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 1:552 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1117
Mailing Address - Country:US
Mailing Address - Phone:234-243-3127
Mailing Address - Fax:330-306-9373
Practice Address - Street 1:552 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1117
Practice Address - Country:US
Practice Address - Phone:234-243-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH22933175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide