Basic Information
| Provider Information | |||||||||
| NPI: | 1447692595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3044 OTTAWA AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554162207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514926643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4050 COON RAPIDS BLVD NW | ||||||||
| Address2: | |||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554332522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632366000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 12/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R180737-0 | MN | N | Nursing Service Providers | Registered Nurse | 367500000X | 100384 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.