Provider Demographics
NPI:1467110999
Name:EASLEY, LAURA RENEE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1960
Mailing Address - Country:US
Mailing Address - Phone:216-224-1597
Mailing Address - Fax:
Practice Address - Street 1:1910 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1960
Practice Address - Country:US
Practice Address - Phone:216-224-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health