Provider Demographics
NPI:1699390005
Name:PERKINS, MADELINE PRISCILLA (RN)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:PRISCILLA
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MADELINE
Other - Middle Name:PRISCILLA
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:CO
Mailing Address - Zip Code:81069-0429
Mailing Address - Country:US
Mailing Address - Phone:585-704-0407
Mailing Address - Fax:
Practice Address - Street 1:275 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:719-621-1929
Practice Address - Fax:719-621-4974
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1660790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.1660790OtherRN LICENSE