Provider Demographics
NPI:1598160657
Name:PERANI, DESIREA (LPN)
Entity Type:Individual
Prefix:
First Name:DESIREA
Middle Name:
Last Name:PERANI
Suffix:
Gender:F
Credentials:LPN
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 217
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:OH
Mailing Address - Zip Code:43730-0217
Mailing Address - Country:US
Mailing Address - Phone:740-605-4349
Mailing Address - Fax:
Practice Address - Street 1:136 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:OH
Practice Address - Zip Code:43730-0217
Practice Address - Country:US
Practice Address - Phone:740-605-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse