Provider Demographics
NPI:1356373005
Name:PERRY, PRISCILLA ANN (WHCNP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0587
Mailing Address - Country:US
Mailing Address - Phone:207-248-3927
Mailing Address - Fax:207-622-0836
Practice Address - Street 1:68 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4096
Practice Address - Country:US
Practice Address - Phone:207-922-3440
Practice Address - Fax:207-922-4010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER027328363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMP0145258OtherDEA
MES50992Medicare UPIN
MEMP0145258OtherDEA