Provider Demographics
NPI:1295720548
Name:EASLEY, ANN CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:CHRISTINE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1001 N MARTEL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6611
Mailing Address - Country:US
Mailing Address - Phone:323-436-5018
Mailing Address - Fax:323-436-5034
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-215-1725
Practice Address - Fax:323-205-3867
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2017-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA6904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S10555Medicare UPIN