Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 21060 | NV |
N | 2086S0122X | Plastic and Reconstructive Surgery | 21060 | NV |
NPI | 1902223167 |
---|---|
Provider Name | Nichole A Joslyn Eastham |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15081606 | CAQH (01) | |
1902223167 | (05) | NV |