Individual
MRS. JENNINE A EASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
717 LAND PL, MILWAUKEE, WI 53205-2358
(414) 795-5753
Mailing address
717 LAND PL, MILWAUKEE, WI 53205-2358
(414) 795-5753
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200568-30
WI
227800000X
Certified Respiratory Therapist
1470-28
WI
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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