Provider Demographics
NPI:1740433499
Name:PERRY, AWANA ARKEESHIA
Entity type:Individual
Prefix:MRS
First Name:AWANA
Middle Name:ARKEESHIA
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AWANA
Other - Middle Name:ARKEESHIA
Other - Last Name:BREWINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3801 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2240
Mailing Address - Country:US
Mailing Address - Phone:612-483-1864
Mailing Address - Fax:
Practice Address - Street 1:3801 E 54TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2240
Practice Address - Country:US
Practice Address - Phone:612-483-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility