Provider Demographics
NPI:1689127029
Name:PERRINE, RITA (AGAC-NP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:PERRINE
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 DEGOOD RD
Mailing Address - Street 2:
Mailing Address - City:OSTRANDER
Mailing Address - State:OH
Mailing Address - Zip Code:43061-9764
Mailing Address - Country:US
Mailing Address - Phone:740-666-9401
Mailing Address - Fax:
Practice Address - Street 1:6150 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1574
Practice Address - Country:US
Practice Address - Phone:614-546-4621
Practice Address - Fax:614-546-4536
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH307753363LG0600X, 363LA2100X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider