Provider Demographics
NPI:1053696989
Name:NORDSTROM, PERRICE ANN (RN, CDE)
Entity type:Individual
Prefix:
First Name:PERRICE
Middle Name:ANN
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:PERRICE
Other - Middle Name:ANN
Other - Last Name:NORDSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN CDE
Mailing Address - Street 1:219 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2006
Mailing Address - Country:US
Mailing Address - Phone:716-878-1223
Mailing Address - Fax:716-878-1230
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-1223
Practice Address - Fax:716-878-1230
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse