Provider Demographics
NPI:1235409046
Name:PERRY, ANDREA DELOIS (CNA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DELOIS
Last Name:PERRY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 FOOTE PARK LN APT 102
Mailing Address - Street 2:1522 GENESIS CIR. #202
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-3264
Mailing Address - Country:US
Mailing Address - Phone:901-503-3405
Mailing Address - Fax:
Practice Address - Street 1:475 FOOTE PARK LN APT 102
Practice Address - Street 2:1522 GENESIS CIR. #202
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-3264
Practice Address - Country:US
Practice Address - Phone:901-503-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111004657163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory