Provider Demographics
NPI:1750344024
Name:PEASE, MARITA LUANN (FNP)
Entity type:Individual
Prefix:
First Name:MARITA
Middle Name:LUANN
Last Name:PEASE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 WEST 10TH
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1377
Mailing Address - Country:US
Mailing Address - Phone:317-430-2941
Mailing Address - Fax:317-988-4696
Practice Address - Street 1:1041 WEST 10TH STREET
Practice Address - Street 2:ROUDEBUSH VAMC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-430-2941
Practice Address - Fax:317-988-4696
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001196A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily