Provider Demographics
NPI:1760470835
Name:MAESE, PETER MICHAEL (APRN-FNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:MICHAEL
Last Name:MAESE
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:MS
Other - First Name:P.M.
Other - Middle Name:MICHAEL
Other - Last Name:MAESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-FNP
Mailing Address - Street 1:7050 AIR DEPOT BLVD BLDG 1094
Mailing Address - Street 2:
Mailing Address - City:TINKER AFB
Mailing Address - State:OK
Mailing Address - Zip Code:73145-8716
Mailing Address - Country:US
Mailing Address - Phone:405-582-6689
Mailing Address - Fax:450-736-3128
Practice Address - Street 1:7050 AIR DEPOT BLVD BLDG 1094
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8716
Practice Address - Country:US
Practice Address - Phone:405-582-6689
Practice Address - Fax:405-736-3128
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR44799363LF0000X
TX625268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61899Medicare UPIN