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NPI Code Detail

MEDICARE: MS. MARILYN SUZANNE EATON PA C

MEDICARE: MS. MARILYN SUZANNE EATON PA C
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
1363A00000XPhysician AssistantAK333AK
2363A00000XPhysician AssistantPA10005176WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629054333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARILYN SUZANNE EATON PA C
Provider Business Mailing Address
First Line : 834 SHERIDAN ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2443
Country : US
Telephone Number : 360-385-2200
Fax Number :
Provider Business Practice Location Address
First Line : 834 SHERIDAN ST
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2443
Country : US
Telephone Number : 360-385-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 08/08/2007

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