Provider Demographics
NPI:1003888975
Name:RUSPANTINE, PERINO V (CRNA)
Entity Type:Individual
Prefix:
First Name:PERINO
Middle Name:V
Last Name:RUSPANTINE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:PERRY
Other - Middle Name:V
Other - Last Name:RUSPANTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:82 BARNACLE RD
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2016
Mailing Address - Country:US
Mailing Address - Phone:508-362-2791
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-562-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23073367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered