Provider Demographics
NPI:1922356724
Name:PERRY, SUSAN JANE (REGISTERED NURSE PRA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:PERRY
Suffix:
Gender:F
Credentials:REGISTERED NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CENTERVILLE RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4342
Mailing Address - Country:US
Mailing Address - Phone:401-821-4100
Mailing Address - Fax:401-823-9180
Practice Address - Street 1:469 CENTERVILLE RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4342
Practice Address - Country:US
Practice Address - Phone:401-821-4100
Practice Address - Fax:401-823-9180
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00135363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health