Provider Demographics
NPI:1700521622
Name:PERIAN, NICOLE PAIGE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:PAIGE
Last Name:PERIAN
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 1:14061 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4337
Mailing Address - Country:US
Mailing Address - Phone:248-842-6721
Mailing Address - Fax:
Practice Address - Street 1:14061 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4337
Practice Address - Country:US
Practice Address - Phone:248-842-6721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306006367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered