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NPI Code Detail

MEDICARE: ANNALISE EATON

MEDICARE: ANNALISE EATON
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
1103K00000XBehavior Analyst11301529-2506UT

General Provider Information

NPI Number : 1770186579
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNALISE EATON
Provider Business Mailing Address
First Line : 114 W 870 N
Second Line :
City : OREM
State : UT
Zip : 84057-5833
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1250 HILLRISE CIR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4741
Country : US
Telephone Number : 888-805-0759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 03/25/2026

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Directions to “ ANNALISE EATON ” Practice Location

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