Provider Demographics
NPI:1659638971
Name:PEELER BRYAN, PAULA MARIE NATASHA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA MARIE
Middle Name:NATASHA
Last Name:PEELER BRYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAULA MARIE
Other - Middle Name:NATASHA
Other - Last Name:PEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-2909
Mailing Address - Country:US
Mailing Address - Phone:301-613-7985
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:301-613-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430535-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care