Provider Demographics
NPI:1013751254
Name:PERRINE, TERESA D
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:PERRINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1088
Mailing Address - Country:US
Mailing Address - Phone:513-491-2914
Mailing Address - Fax:
Practice Address - Street 1:408 N GREEN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1088
Practice Address - Country:US
Practice Address - Phone:513-491-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide