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General NPI Number Information
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NPI Number | 1790493443
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Entity Type | Individual
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Provider Name | PERRIE VANPEMBROOK
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Gender | Female
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 1115 S HEMLOCK ST STE 1
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3800
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Country | US
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Telephone | 906-774-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 97 S 4TH ST STE C
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City | ISHPEMING
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State | MI
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Zip | 49849-2168
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Country | US
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Telephone | 906-228-9699
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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 | 4704167215
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License Number State | MI
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