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 1:590 MEDICAL CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:817-608-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2025-02-04
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