MEDICARE: MRS. CAROL EASTON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse		IL

General Provider Information

NPI Number	:	1215050224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL EASTON RN

Provider Business Mailing Address
First Line	:	172 E WALNUT ST
Second Line	:
City	:	NASHVILLE
State	:	IL
Zip	:	62263-1717
Country	:	US
Telephone Number	:	618-214-7137
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 E JACKSON ST
Second Line	:
City	:	DU QUOIN
State	:	IL
Zip	:	62832-2427
Country	:	US
Telephone Number	:	618-542-4731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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