Provider Demographics
NPI:1295446797
Name:EASTON, PHILLIP LYNN SR (RN)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:LYNN
Last Name:EASTON
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:TILDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62292-0076
Mailing Address - Country:US
Mailing Address - Phone:618-443-7801
Mailing Address - Fax:
Practice Address - Street 1:1130 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5007
Practice Address - Country:US
Practice Address - Phone:618-351-1031
Practice Address - Fax:618-351-1107
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41300529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse