Provider Demographics
NPI:1619677101
Name:PERRINE, VALDETTA JEAN (CNP)
Entity Type:Individual
Prefix:
First Name:VALDETTA
Middle Name:JEAN
Last Name:PERRINE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2168
Mailing Address - Country:US
Mailing Address - Phone:517-295-1066
Mailing Address - Fax:
Practice Address - Street 1:905 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2168
Practice Address - Country:US
Practice Address - Phone:517-295-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025609363LF0000X
MI4704209716363LF0000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily