Provider Demographics
NPI:1619036746
Name:PEERY, IDELETTE BLANCHE (RN)
Entity Type:Individual
Prefix:
First Name:IDELETTE
Middle Name:BLANCHE
Last Name:PEERY
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 1:195 N ESKEW LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78612-3235
Mailing Address - Country:US
Mailing Address - Phone:512-303-6906
Mailing Address - Fax:
Practice Address - Street 1:2010 SEVEN MAPLES DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-1726
Practice Address - Country:US
Practice Address - Phone:281-360-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526453163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health