Provider Demographics
NPI:1558065383
Name:PEREZ RODRIGUEZ, AGUSTIN (NP)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:PEREZ RODRIGUEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W GIER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-2940
Mailing Address - Country:US
Mailing Address - Phone:517-894-3357
Mailing Address - Fax:
Practice Address - Street 1:113 W GIER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-2940
Practice Address - Country:US
Practice Address - Phone:517-894-3357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily