Provider Demographics
NPI:1376539783
Name:EASLEY, JOSEPH LEE (PNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:EASLEY
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HAWTHORN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-1028
Mailing Address - Country:US
Mailing Address - Phone:618-548-4590
Mailing Address - Fax:618-548-8275
Practice Address - Street 1:1275 HAWTHORN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-1028
Practice Address - Country:US
Practice Address - Phone:618-548-4590
Practice Address - Fax:618-548-8275
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN28947363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics