Provider Demographics
NPI:1295215374
Name:EASTON, ANDREW VERNON II
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:VERNON
Last Name:EASTON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 MIDWAY CT APT D
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1591
Mailing Address - Country:US
Mailing Address - Phone:618-964-0463
Mailing Address - Fax:
Practice Address - Street 1:1143 MIDWAY CT APT D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1591
Practice Address - Country:US
Practice Address - Phone:618-964-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043-082899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse