Provider Demographics
NPI:1033699509
Name:PERREAULT, ASHLEY N (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:N
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:N
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:500 N WALL ST STE C100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:844-404-4787
Mailing Address - Fax:815-936-3243
Practice Address - Street 1:500 N WALL ST STE C100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:844-404-4787
Practice Address - Fax:815-936-3243
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041408316163W00000X
IL209018073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse