Provider Demographics
NPI:1659086148
Name:EASLEY, SALLY LYNNE (MSN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:LYNNE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:LYNNE
Other - Last Name:DRENNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:LOYALTON
Mailing Address - State:CA
Mailing Address - Zip Code:96118-0807
Mailing Address - Country:US
Mailing Address - Phone:530-993-6730
Mailing Address - Fax:
Practice Address - Street 1:202 FRONT ST
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118-5752
Practice Address - Country:US
Practice Address - Phone:530-993-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95018534OtherFURNISHING NUMBER
CA95018534OtherLICENSE NUMBER