Provider Demographics
NPI:1659007714
Name:PEREZ, PRISCYLA YARELY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:PRISCYLA
Middle Name:YARELY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 57TH AVE APT 10D
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3450
Mailing Address - Country:US
Mailing Address - Phone:347-975-1331
Mailing Address - Fax:
Practice Address - Street 1:9602 57TH AVE APT 10D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3450
Practice Address - Country:US
Practice Address - Phone:347-975-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344472164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse