Provider Demographics
NPI:1568989986
Name:EALY, NECOLE
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:
Last Name:EALY
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 1:6905 AUKLET LN
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2654
Mailing Address - Country:US
Mailing Address - Phone:702-302-9133
Mailing Address - Fax:
Practice Address - Street 1:6905 AUKLET LN
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084
Practice Address - Country:US
Practice Address - Phone:702-302-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst