Provider Demographics
NPI:1356113831
Name:PEASE, KRISTEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PEASE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SIEMERS ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-1833
Mailing Address - Country:US
Mailing Address - Phone:608-778-9866
Mailing Address - Fax:
Practice Address - Street 1:1030 SIEMERS ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-1833
Practice Address - Country:US
Practice Address - Phone:608-778-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14643-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily