Individual
JACOB MANUEL PERREIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP
Contact information
Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 988-1772
Mailing address
5843 MINDEN DR, INDIANAPOLIS, IN 46221-9379
(815) 474-7660
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
28251946A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
28251946A
IN
Other
Enumeration date
03/01/2022
Last updated
08/24/2022
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