Individual
JILL C PEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
3554 PROMENADE PKWY, SUITE H, LAFAYETTE, IN 47909-8417
(765) 471-1100
Mailing address
3554 PROMENADE PKWY, SUITE H, LAFAYETTE, IN 47909-8417
(765) 471-1100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000824A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000540149
ANTHEM PROVIDER NUMBER
IN
Enumeration date
11/30/2005
Last updated
06/16/2015
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