Provider Demographics
NPI:1598827511
Name:EASLEY, BRIDGET SUZANNE (MS RD LMNT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:SUZANNE
Last Name:EASLEY
Suffix:
Gender:F
Credentials:MS RD LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1530 SO 70TH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68501-1567
Mailing Address - Country:US
Mailing Address - Phone:402-488-2348
Mailing Address - Fax:402-488-2463
Practice Address - Street 1:1530 SO 70TH
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68501-1567
Practice Address - Country:US
Practice Address - Phone:402-488-2348
Practice Address - Fax:402-488-2463
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025266400Medicaid