Provider Demographics
NPI:1821709270
Name:PEERY, NICOLE LORRAINE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LORRAINE
Last Name:PEERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 RICH VIEW DR APT 106
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-9789
Mailing Address - Country:US
Mailing Address - Phone:304-435-1347
Mailing Address - Fax:
Practice Address - Street 1:173 RICH VIEW DR APT 106
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-9789
Practice Address - Country:US
Practice Address - Phone:304-435-1347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant