Individual
PHYLLIS EASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-3100
(701) 234-3120
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
043926
GA
2084P0800X
Psychiatry Physician
2015042689
MO
2084P0800X
Psychiatry Physician
71925
WI
2084P0800X
Psychiatry Physician
C170232
CA
2084P0800X
Psychiatry Physician
MD61499166
WA
2084P0800X
Psychiatry Physician
Primary
PT12912
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174596746
—
MN
05
—
18207
—
ND
Enumeration date
02/13/2006
Last updated
11/05/2024
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