Provider Demographics
NPI:1891760948
Name:EASLEY, ELIZABETH (APRN BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EASLEY
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 W CENTER RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-354-8035
Mailing Address - Fax:402-354-8044
Practice Address - Street 1:9239 W CENTER RD
Practice Address - Street 2:SUITE 222
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-354-8035
Practice Address - Fax:402-354-8044
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110089163WP0808X
NE28778163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084610626Medicaid
099147Medicare ID - Type Unspecified
NE47084610626Medicaid