Provider Demographics
NPI:1710687918
Name:PERDEW, REINA E (FNP-C)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:E
Last Name:PERDEW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2933
Mailing Address - Country:US
Mailing Address - Phone:667-280-7066
Mailing Address - Fax:
Practice Address - Street 1:72 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2933
Practice Address - Country:US
Practice Address - Phone:667-280-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-14
Deactivation Date:2023-03-09
Deactivation Code:
Reactivation Date:2023-03-14
Provider Licenses
StateLicense IDTaxonomies
MDAC005089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily