Provider Demographics
NPI:1700470838
Name:PERINE, NARESA
Entity type:Individual
Prefix:
First Name:NARESA
Middle Name:
Last Name:PERINE
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 1:2366 GOOSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PETROLEUM
Mailing Address - State:WV
Mailing Address - Zip Code:26161-6425
Mailing Address - Country:US
Mailing Address - Phone:304-628-3214
Mailing Address - Fax:
Practice Address - Street 1:2366 GOOSE CREEK RD
Practice Address - Street 2:
Practice Address - City:PETROLEUM
Practice Address - State:WV
Practice Address - Zip Code:26161-6425
Practice Address - Country:US
Practice Address - Phone:304-628-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker