Provider Demographics
NPI:1720561715
Name:PERRIN, LAURA M (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:PERRIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1316
Mailing Address - Country:US
Mailing Address - Phone:973-543-1716
Mailing Address - Fax:
Practice Address - Street 1:16 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1316
Practice Address - Country:US
Practice Address - Phone:973-543-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG07180235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner