Provider Demographics
NPI:1215686142
Name:EASTER, ETHEL RAINEY
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:RAINEY
Last Name:EASTER
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 1:5644 BOYDTON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-2156
Mailing Address - Country:US
Mailing Address - Phone:434-774-4561
Mailing Address - Fax:
Practice Address - Street 1:5644 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:BRODNAX
Practice Address - State:VA
Practice Address - Zip Code:23920-2156
Practice Address - Country:US
Practice Address - Phone:434-774-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No385H00000XRespite Care FacilityRespite Care