Provider Demographics
NPI:1174514723
Name:PEASE, DAWN CAROLINE (ANP, WHCNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:CAROLINE
Last Name:PEASE
Suffix:
Gender:F
Credentials:ANP, WHCNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:TOEDTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 MONTOPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6411
Mailing Address - Country:US
Mailing Address - Phone:512-978-9901
Mailing Address - Fax:512-901-9765
Practice Address - Street 1:2901 MONTOPOLIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6411
Practice Address - Country:US
Practice Address - Phone:512-978-9901
Practice Address - Fax:512-901-9765
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003232363L00000X
TXAP115802363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235976Medicaid
TX294106402Medicaid
CT004235976Medicaid
TX379339YMGJMedicare PIN
Q51563Medicare UPIN