Provider Demographics
NPI:1801250519
Name:PERREAULT, LISA G (FNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CORPORATE CENTRE DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2611
Mailing Address - Country:US
Mailing Address - Phone:615-721-7024
Mailing Address - Fax:800-266-5158
Practice Address - Street 1:1163 PITTSFORD VICTOR RD
Practice Address - Street 2:SUITE 140
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3835
Practice Address - Country:US
Practice Address - Phone:855-398-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily