Provider Demographics
NPI:1215005228
Name:PERRENOUD, NICHOLAS ARTHUR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ARTHUR
Last Name:PERRENOUD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:42718 SETTLERS RDG
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3313
Mailing Address - Country:US
Mailing Address - Phone:909-800-2686
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST RM A504
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-7811
Practice Address - Fax:909-558-0180
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576417163WH0200X
CA3555367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WH0200XNursing Service ProvidersRegistered NurseHome Health