Provider Demographics
NPI:1790959906
Name:PERRY, ANNA (LAC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1032 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3064
Mailing Address - Country:US
Mailing Address - Phone:651-227-6865
Mailing Address - Fax:
Practice Address - Street 1:1032 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3064
Practice Address - Country:US
Practice Address - Phone:651-227-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist