Provider Demographics
NPI:1841225901
Name:EASTON, CONSTANCE DIANE (CNM)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:DIANE
Last Name:EASTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:#215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:2231 W CHARLESTON BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2254
Practice Address - Country:US
Practice Address - Phone:702-383-2403
Practice Address - Fax:702-383-1837
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN5685367A00000X
NVAPN001032367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1841225901Medicaid
AZ339971OtherAHCCCS
NV1841225901OtherMEDICARE