Provider Demographics
NPI:1376397711
Name:PERRY, ANGIE M
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:M
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 1:201 NUNNEMACHER ST APT 1-5
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49968-1363
Mailing Address - Country:US
Mailing Address - Phone:906-364-9476
Mailing Address - Fax:
Practice Address - Street 1:207 NUNNEMACHER ST APT 7-5
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968-1360
Practice Address - Country:US
Practice Address - Phone:906-458-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide