Provider Demographics
NPI:1255663704
Name:PERRY, SAMRET OLIVETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:SAMRET
Middle Name:OLIVETTE
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WEST MOSHOLU PKWY SOUTH
Mailing Address - Street 2:23D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:646-288-4433
Mailing Address - Fax:
Practice Address - Street 1:40 WEST MOSHOLU PKWY SOUTH
Practice Address - Street 2:23D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:646-288-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22576311163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse