MEDICARE: SONJA LEA EATON R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	490539	CA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	201391896RN	OR
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1518991660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA LEA EATON R.N.

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 SE 43RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1600
Country	:	US
Telephone Number	:	503-238-0705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	10/29/2013

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