Provider Demographics
NPI:1275974446
Name:EASLEY, CARMILLE S (LPN)
Entity Type:Individual
Prefix:
First Name:CARMILLE
Middle Name:S
Last Name:EASLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11279
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-0279
Mailing Address - Country:US
Mailing Address - Phone:513-969-9438
Mailing Address - Fax:
Practice Address - Street 1:222 E CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1225
Practice Address - Country:US
Practice Address - Phone:513-969-9438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN153333-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse