Provider Demographics
NPI:1700028362
Name:PERKEY NIENABER, ERIN LEIGH (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LEIGH
Last Name:PERKEY NIENABER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:PERKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:1425 N FAIRFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2674
Practice Address - Country:US
Practice Address - Phone:937-320-3888
Practice Address - Fax:937-320-3848
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010047208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000767286OtherANTHEM
OH34.010047OtherMEDICAL LICENSE
OH0065649Medicaid