Provider Demographics
NPI:1730244989
Name:PEASE, VICKI LYNN (RN, NP-C)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:PEASE
Suffix:
Gender:F
Credentials:RN, NP-C
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Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:
Practice Address - Street 1:7060 N RECREATION AVE
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8022
Practice Address - Country:US
Practice Address - Phone:559-325-5656
Practice Address - Fax:559-325-5568
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA368983163W00000X
CA11626363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse