Provider Demographics
NPI:1558815316
Name:PERRY, MARION LOUISE (RN, BFA)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:LOUISE
Last Name:PERRY
Suffix:
Gender:F
Credentials:RN, BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3194 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2536
Mailing Address - Country:US
Mailing Address - Phone:585-747-3286
Mailing Address - Fax:
Practice Address - Street 1:3194 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2536
Practice Address - Country:US
Practice Address - Phone:585-747-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY653459-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse