Provider Demographics
NPI:1902395502
Name:PERRY, HENRY LEWIS (RN)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LEWIS
Last Name:PERRY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LINDEN AVE APT 30
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5031
Mailing Address - Country:US
Mailing Address - Phone:562-310-3215
Mailing Address - Fax:562-612-0270
Practice Address - Street 1:65 LINDEN AVE APT 30
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5031
Practice Address - Country:US
Practice Address - Phone:562-310-3215
Practice Address - Fax:562-612-0270
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766291163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency