Provider Demographics
NPI:1730703976
Name:PERLKIN, HANNAH ROSE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:PERLKIN
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 1:7766 HEALDSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3352
Mailing Address - Country:US
Mailing Address - Phone:707-494-1867
Mailing Address - Fax:
Practice Address - Street 1:431 HUMBOLDT ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4288
Practice Address - Country:US
Practice Address - Phone:707-205-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist