Provider Demographics
NPI:1205851490
Name:PERKOWSKI, MARILYN J (CNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 WALES AVE NW
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-830-9378
Mailing Address - Fax:330-830-1534
Practice Address - Street 1:2037 WALES AVE NW
Practice Address - Street 2:SUITE 130
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-830-9378
Practice Address - Fax:330-830-1534
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN135276363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCN1167OtherRRMC
OH2314061Medicaid
OHCC3678OtherRRMC
OH500019409OtherRRMC
OHCF7408OtherRRMC
OHP13211Medicare UPIN
OHCF7408OtherRRMC
OH500019409OtherRRMC
OH2314061Medicaid