Provider Demographics
NPI:1922460344
Name:PERELGUT, ADAM (FNP-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PERELGUT
Suffix:
Gender:M
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 1:25195 SW PARKWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9689
Mailing Address - Country:US
Mailing Address - Phone:971-236-1199
Mailing Address - Fax:
Practice Address - Street 1:25195 SW PARKWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9689
Practice Address - Country:US
Practice Address - Phone:971-236-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2023-03-29
Deactivation Date:2023-03-17
Deactivation Code:
Reactivation Date:2023-03-24
Provider Licenses
StateLicense IDTaxonomies
OR202003288NP363LF0000X
NVAPRN002173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily