Provider Demographics
NPI:1730635707
Name:EASON, COURTNEY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:EASON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 41ST ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-1147
Mailing Address - Country:US
Mailing Address - Phone:516-580-9540
Mailing Address - Fax:
Practice Address - Street 1:493 41ST ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-1147
Practice Address - Country:US
Practice Address - Phone:516-580-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320961-1164W00000X
NY794749-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No164W00000XNursing Service ProvidersLicensed Practical Nurse