Provider Demographics
NPI:1992771059
Name:PERRY, MILTON DANIEL (CRNP)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:DANIEL
Last Name:PERRY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 WEDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-8415
Mailing Address - Country:US
Mailing Address - Phone:334-361-8503
Mailing Address - Fax:334-241-5281
Practice Address - Street 1:4258 U.S. HIGHWAY 80 WEST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6949
Practice Address - Country:US
Practice Address - Phone:334-847-8800
Practice Address - Fax:334-874-7700
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8832959146L00000X
AL1-064101163WE0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS95102Medicare UPIN