Provider Demographics
NPI:1992336333
Name:PEASE, ASHLEY AUTUMN (CNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AUTUMN
Last Name:PEASE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 GUENIVERE WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-6763
Mailing Address - Country:US
Mailing Address - Phone:559-380-9956
Mailing Address - Fax:
Practice Address - Street 1:161 SE BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3261
Practice Address - Country:US
Practice Address - Phone:559-380-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV862423363L00000X
CA95024490363L00000X
WAAP61002883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner