Basic Information
| Provider Information | |||||||||
| NPI: | 1396129300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREGRIN | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ANDRESKI | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 210 TOWNE VILLAGE DR | ||||||||
| Address2: | WEPPA | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198593373 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 210 TOWNE VILLAGE DR | ||||||||
| Address2: | WEPPA | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198593373 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.