Provider Demographics
NPI:1063749406
Name:EASLICK, JOANN MARIE (RN)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:EASLICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19451 DORIS WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1322
Mailing Address - Country:US
Mailing Address - Phone:714-731-5238
Mailing Address - Fax:714-731-4236
Practice Address - Street 1:19451 DORIS WAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1322
Practice Address - Country:US
Practice Address - Phone:714-731-5238
Practice Address - Fax:714-731-4236
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse