Provider Demographics
NPI:1134579428
Name:EASLEY, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:EASLEY
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 1:2870 NETHERTON DR
Mailing Address - Street 2:STE 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-4649
Mailing Address - Country:US
Mailing Address - Phone:314-339-0061
Mailing Address - Fax:
Practice Address - Street 1:2870 NETHERTON DR
Practice Address - Street 2:STE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4649
Practice Address - Country:US
Practice Address - Phone:314-339-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health