Provider Demographics
NPI:1730611195
Name:PERRY, TYIRESHIA MICHELLE
Entity type:Individual
Prefix:
First Name:TYIRESHIA
Middle Name:MICHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23111 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3635
Mailing Address - Country:US
Mailing Address - Phone:313-681-9312
Mailing Address - Fax:
Practice Address - Street 1:23111 KIPLING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3635
Practice Address - Country:US
Practice Address - Phone:313-681-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula