Healthcare Provider Details

I. General information

NPI: 1477587426
Provider Name (Legal Business Name): ALESIA EATON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-3561
US

IV. Provider business mailing address

5430 FREDERICKSBURG RD STE 508
SAN ANTONIO TX
78229-3561
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-2000
  • Fax:
Mailing address:
  • Phone: 210-541-8281
  • Fax: 210-541-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP106521
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number540139
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209030812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: