Provider Demographics
NPI:1043499965
Name:PERRONE, SUSAN LORRAINE (PA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LORRAINE
Last Name:PERRONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18924 BRIARGATE LN
Mailing Address - Street 2:#2B
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3677
Mailing Address - Country:US
Mailing Address - Phone:303-993-3725
Mailing Address - Fax:
Practice Address - Street 1:18924 BRIARGATE LN
Practice Address - Street 2:#2B
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3677
Practice Address - Country:US
Practice Address - Phone:303-993-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant