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General NPI Number Information
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NPI Number | 1316488422
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Entity Type | Individual
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Provider Name | ADAM JOSEPH PERISSINOTTI CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 4201 SAINT ANTOINE ST
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 CARRIAGE LANE
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City | LASALLE
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State | ONTARIO
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Zip | N9H 1Z8
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Country | CA
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 200965-6
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704285098
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN1033014
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704285098
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License Number State | MI
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