=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902417926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LOUISE PERNE NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2020
-----------------------------------------------------
Last Update Date | 08/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE UNIVERSITY OF TOLEDO MEDICAL CENTER 3000 ARLINGTON AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-383-3812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4030 W BANCROFT ST APT 2
-----------------------------------------------------
City | OTTAWA HILLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43606-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-377-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F07191302
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------