Provider Demographics
NPI:1912241860
Name:PERDUE, CHRISTINE TANNER (RN, MSN,CPNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:TANNER
Last Name:PERDUE
Suffix:
Gender:F
Credentials:RN, MSN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SCHUMAKER WOODS RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8724
Mailing Address - Country:US
Mailing Address - Phone:703-731-2517
Mailing Address - Fax:
Practice Address - Street 1:1415 WESLEY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-912-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001095363LP0200X
MDR213671363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics