MEDICARE: DR. REBECCA RACHEL 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	163W00000X	Registered Nurse	338773-3102	UT
2	207V00000X	Obstetrics & Gynecology Physician	338773-3102	UT
3	163WX0003X	Inpatient Obstetric Registered Nurse	338773-3102	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	338773-3102	OTHER	UT	DOPL

General Provider Information

NPI Number	:	1538900337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA RACHEL EATON

Provider Business Mailing Address
First Line	:	13869 S CORA B LN
Second Line	:
City	:	HERRIMAN
State	:	UT
Zip	:	84096-6940
Country	:	US
Telephone Number	:	801-889-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E CAMPUS CENTER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-8914
Country	:	US
Telephone Number	:	801-889-0670
Fax Number	:

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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