Provider Demographics
NPI:1457862013
Name:PERRY, LANITA DENISE
Entity Type:Individual
Prefix:
First Name:LANITA
Middle Name:DENISE
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 1:31600 N MARGINAL DR APT E
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4409
Mailing Address - Country:US
Mailing Address - Phone:216-466-2918
Mailing Address - Fax:
Practice Address - Street 1:31600 N MARGINAL DR APT E
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-4409
Practice Address - Country:US
Practice Address - Phone:216-466-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161590164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH161590OtherLICENSED PRACTICAL NURSE