Healthcare Provider Details

I. General information

NPI: 1033699509
Provider Name (Legal Business Name): ASHLEY N PERREAULT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY N PARKS NP-C

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N WALL ST STE C100
KANKAKEE IL
60901-2942
US

IV. Provider business mailing address

500 N WALL ST STE C100
KANKAKEE IL
60901-2942
US

V. Phone/Fax

Practice location:
  • Phone: 844-404-4787
  • Fax: 815-936-3243
Mailing address:
  • Phone: 844-404-4787
  • Fax: 815-936-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041408316
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: