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General NPI Number Information
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NPI Number | 1336423896
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE EATON JR. F.N.P
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Gender | Male
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 1430 S MAIN ST SUITE NUMBER 111
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City | BOERNE
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State | TX
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Zip | 78006-3332
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Country | US
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Telephone | 830-331-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 27818 WILD BLOOM
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City | SAN ANTONIO
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State | TX
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Zip | 78260-1437
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Country | US
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Telephone | 830-331-8585
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 648521
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License Number State | TX
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