Provider Demographics
NPI:1164617775
Name:EASTER, BENNA L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BENNA
Middle Name:L
Last Name:EASTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 NW CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1266
Mailing Address - Country:US
Mailing Address - Phone:641-446-4863
Mailing Address - Fax:641-446-3576
Practice Address - Street 1:802 ACKERLY ST
Practice Address - Street 2:
Practice Address - City:LAMONI
Practice Address - State:IA
Practice Address - Zip Code:50140-1544
Practice Address - Country:US
Practice Address - Phone:641-784-3371
Practice Address - Fax:641-784-6162
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-054747363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner