Provider Demographics
NPI:1033357439
Name:EASTON, ANITA LARAE (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LARAE
Last Name:EASTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-1402
Mailing Address - Country:US
Mailing Address - Phone:308-282-1475
Mailing Address - Fax:
Practice Address - Street 1:EAST HIGHWAY 18
Practice Address - Street 2:PINE RIDGE IHS
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse