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General NPI Number Information
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NPI Number | 1255399333
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Entity Type | Individual
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Provider Name | ALICE AUDREY EATON MD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 3434 12TH AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5175
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Country | US
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Telephone | 360-413-8364
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Fax | 360-413-8491
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Provider Business Mailing Address
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Address Line | 8079 SW SACAJAWEA WAY
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City | WILSONVILLE
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State | OR
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Zip | 97070-6428
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Country | US
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Telephone | 503-784-2490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD 00030157
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | MD 00030157
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD16709
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License Number State | OR
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