Healthcare Provider Details

I. General information

NPI: 1083722185
Provider Name (Legal Business Name): VICKI L EASON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 GROVE RD SUITE B
GREENVILLE SC
29605-4656
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-8897
  • Fax: 864-455-6598
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: