MEDICARE: SARA DERRINGER PEASE CNP

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
1	363LF0000X	Family Nurse Practitioner	09718NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972792059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA DERRINGER PEASE CNP

Provider Business Mailing Address
First Line	:	PO BOX 645409
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15264-5252
Country	:	US
Telephone Number	:	330-386-6442
Fax Number	:	330-386-3660

Provider Business Practice Location Address
First Line	:	16761 SAINT CLAIR AVE # 2
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-932-3301
Fax Number	:	330-368-0957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/08/2021

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