MEDICARE: JOCELYN J PERDEAU CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN-268844	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.07311	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00193327	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01973	OTHER	OH	PARAMOUNT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000213037	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1265417364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELYN J PERDEAU CNP

Provider Business Mailing Address
First Line	:	36115 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1216
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

Provider Business Practice Location Address
First Line	:	111 CLINTON ST
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-2811
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	07/01/2025

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