Provider Demographics
NPI:1083771075
Name:EATON, KIMBERLEY (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1414
Mailing Address - Country:US
Mailing Address - Phone:330-297-0811
Mailing Address - Fax:
Practice Address - Street 1:25501 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5603
Practice Address - Country:US
Practice Address - Phone:216-545-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000312061OtherANTHEM PROVIDER NUMBER
OHH062513OtherMEDICARE
OH2466246Medicaid