Individual
JACKIE RENEA' PERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4350 APPLETON PLACE, KETTERING, OH 45440-4532
(937) 603-9841
Mailing address
2888 VALLEYVIEW DR, FAIRBORN, OH 45324-2252
(937) 603-9841
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
137852.MEDS-IV
OH
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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