Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 67245 | WV |
NPI | 1013130178 |
---|---|
Provider Name | Mary Lynne Perkins |
First Address | Williamsport, MD 21795-1401 |
Second Address | Martinsburg, WV 25401-1134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |