Provider Demographics
NPI:1235457276
Name:PEERY, DOROTHY ANN
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ANN
Last Name:PEERY
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 1:5515 COUNTY ROAD 420
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-6773
Mailing Address - Country:US
Mailing Address - Phone:573-355-1489
Mailing Address - Fax:
Practice Address - Street 1:5515 COUNTY ROAD 420
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-6773
Practice Address - Country:US
Practice Address - Phone:573-355-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOS036235006172A00000X
372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No172A00000XOther Service ProvidersDriver