Provider Demographics
NPI:1891291001
Name:EASLEY, VASHAE' RAKIM
Entity Type:Individual
Prefix:
First Name:VASHAE'
Middle Name:RAKIM
Last Name:EASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 BURR RIDGE CT APT 201
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-6815
Mailing Address - Country:US
Mailing Address - Phone:630-806-6525
Mailing Address - Fax:
Practice Address - Street 1:7980 BURR RIDGE CT APT 201
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-6815
Practice Address - Country:US
Practice Address - Phone:630-806-6525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
109055053OtherAETNA BETTER HEALTH