Provider Demographics
NPI:1952459406
Name:PERRI, ANDREA L (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:PERRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-672-4900
Mailing Address - Fax:231-672-3881
Practice Address - Street 1:1675 LEAHY ST STE 404B
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5544
Practice Address - Country:US
Practice Address - Phone:231-728-1695
Practice Address - Fax:231-728-5906
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704110689163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON34010OtherMEDICARE GROUP NUMBER