Provider Demographics
NPI:1396867941
Name:PERNO, MICHELLE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:PERNO
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3193 W HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8437
Practice Address - Country:US
Practice Address - Phone:704-698-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00710363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396867941Medicaid
NC8101342Medicaid
NCNC2786CMedicare PIN
NCNC2786DMedicare PIN
NCNC2786KMedicare PIN
NC8101342Medicaid
NCNC2786EMedicare PIN
NCNC2786GMedicare PIN
NCNC2786AMedicare PIN
NC1396867941Medicaid
NC2771285AMedicare PIN
NCNC2786HMedicare PIN
NCNC2786IMedicare PIN
NCNC2786LMedicare PIN
NCNC2786MMedicare PIN
NCNC2786FMedicare PIN