Provider Demographics
NPI:1639134406
Name:PEASE, KENDALL J (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:J
Last Name:PEASE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:KENDALL
Other - Middle Name:JO
Other - Last Name:ELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:701 2ND ST NE APT 103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5053
Mailing Address - Country:US
Mailing Address - Phone:619-892-2467
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:141-060-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548975367500000X
MDR181696367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered