MEDICARE: EMILY 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
1	390200000X	Student in an Organized Health Care Education/Training Program	IL-UIC (05/22/2014)	IL

General Provider Information

NPI Number	:	1538573258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY EATON

Provider Business Mailing Address
First Line	:	5643 N MAGNOLIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-3486
Country	:	US
Telephone Number	:	312-919-7682
Fax Number	:

Provider Business Practice Location Address
First Line	:	5643 N. MAGNOLIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660
Country	:	US
Telephone Number	:	312-919-7682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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Directions to “ EMILY EATON ” Practice Location

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