Healthcare Provider Details

I. General information

NPI: 1962739631
Provider Name (Legal Business Name): VICKIE L EATON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ORANGE PL STE 2300
BEACHWOOD OH
44122-4468
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-6776
  • Fax: 216-383-6745
Mailing address:
  • Phone: 216-383-6776
  • Fax: 216-383-6745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN178831
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: