Provider Demographics
NPI:1912117532
Name:PERRYMAN, MARSHA D (RN,IBCLC,RLC)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:D
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:RN,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SHEFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-6625
Mailing Address - Country:US
Mailing Address - Phone:630-602-6668
Mailing Address - Fax:
Practice Address - Street 1:12 SHEFFIELD CT
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-6625
Practice Address - Country:US
Practice Address - Phone:630-602-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
19714217OtherIBCLC NUMBER