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NPI Code Detail

MEDICARE: DESIREE PEASE LPN

MEDICARE: DESIREE PEASE LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NursePN258043LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PN258043LOTHERPAPA NURSING LICENSE

General Provider Information

NPI Number : 1114110111
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE PEASE LPN
Provider Business Mailing Address
First Line : 2695 SLOPE HILL RD
Second Line :
City : MT PLEASANT
State : PA
Zip : 15666-8975
Country : US
Telephone Number : 724-984-7290
Fax Number :
Provider Business Practice Location Address
First Line : 2695 SLOPE HILL RD
Second Line :
City : MT PLEASANT
State : PA
Zip : 15666-8975
Country : US
Telephone Number : 724-984-7290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2007
Last Update Date : 06/19/2012

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Directions to “ DESIREE PEASE LPN” Practice Location

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