Provider Demographics
NPI:1114110111
Name:PEASE, DESIREE (LPN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:PEASE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 SLOPE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-8975
Mailing Address - Country:US
Mailing Address - Phone:724-984-7290
Mailing Address - Fax:
Practice Address - Street 1:2695 SLOPE HILL RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-8975
Practice Address - Country:US
Practice Address - Phone:724-984-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN258043L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPN258043LOtherPA NURSING LICENSE