Basic Information
| Provider Information | |||||||||
| NPI: | 1932168754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EASLEY | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 100 CIMARRON CT | ||||||||
| Address2: | |||||||||
| City: | APPLE VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551249722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9526810970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 550 OSBORNE RD NE | ||||||||
| Address2: | RT. 52840 | ||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632365000 | ||||||||
| FaxNumber: | 7632363524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32028 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 32028 | MN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1031906 | 01 | MN | PREFERRED ONE | OTHER | 523P9EA | 01 | MN | BCBS OF MN | OTHER | 142167 | 01 | MN | UCARE | OTHER | 04-07812 | 01 | MN | MEDICA | OTHER | 2443412 | 01 | MN | AMERICA'S PPO | OTHER | 830707500 | 05 | MN | MEDICAID | HP10369 | 01 | MN | HEALTH PARTNERS | OTHER | 0408822 | 01 | MN | MEDICA CHOICE | OTHER |