Provider Demographics
NPI:1841586336
Name:PERDUE, ELLEN ROSE (RN)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ROSE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 GARDEN RANCH LN
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6845
Mailing Address - Country:US
Mailing Address - Phone:530-354-2793
Mailing Address - Fax:
Practice Address - Street 1:5 HILDA WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1417
Practice Address - Country:US
Practice Address - Phone:530-899-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789428163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse