Provider Demographics
NPI:1043330186
Name:EATON, LOIS MARIE (NMD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:MARIE
Last Name:EATON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 FAIR ST
Mailing Address - Street 2:#B
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1803
Mailing Address - Country:US
Mailing Address - Phone:928-778-2882
Mailing Address - Fax:
Practice Address - Street 1:1058 FAIR ST
Practice Address - Street 2:#B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1803
Practice Address - Country:US
Practice Address - Phone:928-778-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-921175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath