Provider Demographics
NPI:1669508248
Name:EASLEY, LAURA CECILIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:CECILIA
Last Name:EASLEY
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 1:405 BRIANS WAY
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-4296
Mailing Address - Country:US
Mailing Address - Phone:707-678-9543
Mailing Address - Fax:
Practice Address - Street 1:405 BRIANS WAY
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-4296
Practice Address - Country:US
Practice Address - Phone:707-678-9543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse