Provider Demographics
NPI:1871924571
Name:PERRIN, ANISSA
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:PERRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1131
Mailing Address - Country:US
Mailing Address - Phone:724-656-8940
Mailing Address - Fax:724-656-8942
Practice Address - Street 1:3105 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1131
Practice Address - Country:US
Practice Address - Phone:724-656-8940
Practice Address - Fax:724-656-8942
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004353363A00000X
PAMA056400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126904Medicaid
OH0126904Medicaid