Most Relevant Information
Provider Data
| NPI Number: | 1003419912 |
| Provider Name: | JUSTIN VERN PERREAULT |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/21/2020 |
| Last Updated: | 11/21/2020 |
Provider Practice Location
925 36TH ST. S.
MOORHEAD
MN
565605656
Practice Location Phone/Fax
| Phone: | 7013181116 |
| Fax: |
Provider Mailing Location
925 36TH ST. S.
MOORHEAD
MN
56560
Provider Mailing Phone/Fax
| Phone: | 7013181116 |
| Fax: |