Provider Demographics
NPI:1629790241
Name:EASTIN, BARBARA ANN
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:EASTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25203
Mailing Address - Street 2:
Mailing Address - City:MUNDS PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:86017-5203
Mailing Address - Country:US
Mailing Address - Phone:928-812-3167
Mailing Address - Fax:
Practice Address - Street 1:640 E CRESTLINE RD
Practice Address - Street 2:
Practice Address - City:MUNDS PARK
Practice Address - State:AZ
Practice Address - Zip Code:86017-0081
Practice Address - Country:US
Practice Address - Phone:928-812-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist