Provider Demographics
NPI:1790484061
Name:EASTERLY, MOANA LYNN
Entity Type:Individual
Prefix:MS
First Name:MOANA
Middle Name:LYNN
Last Name:EASTERLY
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 1:4101 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2252
Mailing Address - Country:US
Mailing Address - Phone:702-954-0052
Mailing Address - Fax:
Practice Address - Street 1:4101 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2252
Practice Address - Country:US
Practice Address - Phone:702-954-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation