Healthcare Provider Details

I. General information

NPI: 1265417364
Provider Name (Legal Business Name): JOCELYN J PERDEAU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLINTON ST
MAUMEE OH
43537-2811
US

IV. Provider business mailing address

36115 SCHOOLCRAFT RD
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-0887
  • Fax: 734-402-0254
Mailing address:
  • Phone: 734-464-0887
  • Fax: 734-402-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.07311
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-268844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: