Provider Demographics
NPI:1477095941
Name:PERCLE, DANETTE (LVN)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:PERCLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 CAMINO LA MADERA UNIT B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1768
Mailing Address - Country:US
Mailing Address - Phone:619-578-9200
Mailing Address - Fax:
Practice Address - Street 1:1137 CAMINO LA MADERA UNIT B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1768
Practice Address - Country:US
Practice Address - Phone:619-578-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 290869164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse