Provider Demographics
NPI:1093917775
Name:PERRINE, NITA LOUISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:NITA
Middle Name:LOUISE
Last Name:PERRINE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22116 E LOST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-5482
Mailing Address - Country:US
Mailing Address - Phone:360-668-3926
Mailing Address - Fax:
Practice Address - Street 1:22116 E LOST LAKE RD
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5482
Practice Address - Country:US
Practice Address - Phone:360-668-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist