Provider Demographics
NPI:1093284564
Name:EATMON, CIARA L (NP)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:L
Last Name:EATMON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:19179 MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1017
Mailing Address - Country:US
Mailing Address - Phone:313-605-0095
Mailing Address - Fax:
Practice Address - Street 1:18700 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-2923
Practice Address - Country:US
Practice Address - Phone:313-925-3486
Practice Address - Fax:313-925-3497
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95010333363L00000X
MI1093284564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner