Provider Demographics
NPI:1407567589
Name:EASTMAN, LEISA (RN)
Entity Type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MISSION RD STE 211
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6712
Mailing Address - Country:US
Mailing Address - Phone:907-486-3319
Mailing Address - Fax:
Practice Address - Street 1:211 MISSION RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6712
Practice Address - Country:US
Practice Address - Phone:907-486-3319
Practice Address - Fax:907-486-8149
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200735163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse