Provider Demographics
NPI:1093978967
Name:EASLEY, ELSIE R
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:R
Last Name:EASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 EQUINOX WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-6303
Mailing Address - Country:US
Mailing Address - Phone:916-421-2145
Mailing Address - Fax:916-421-2145
Practice Address - Street 1:4212 EQUINOX WY.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-6303
Practice Address - Country:US
Practice Address - Phone:916-421-2145
Practice Address - Fax:916-421-2145
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN104912164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse