Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 382685 | NY |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382685 | NY |
NPI | 1033196514 |
---|---|
Provider Name | Margaret Ann Pease |
First Address | Elmira, NY 14901-3230 |
Second Address | Elmira, NY 14901-3219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 25/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000841948G | (05) | GA |
04627116 | (05) | NY |