Provider Demographics
NPI:1932597523
Name:CONNELL, PERRI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PERRI
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:PERRI
Other - Middle Name:
Other - Last Name:SOMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2441B S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433-1030
Mailing Address - Country:US
Mailing Address - Phone:585-797-8932
Mailing Address - Fax:
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3071
Practice Address - Country:US
Practice Address - Phone:253-985-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8943623OtherMEDICARE