Individual
LASANDRA EASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 RAVENCREST DR, LONGVIEW, TX 75605-1531
(903) 445-0103
Mailing address
1211 RAVENCREST DR, LONGVIEW, TX 75605-1531
(903) 445-0103
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
1013944
TX
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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