Provider Demographics
NPI:1356687131
Name:EATHERTON, SEAN (RN)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:EATHERTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1635
Mailing Address - Country:US
Mailing Address - Phone:314-832-1246
Mailing Address - Fax:
Practice Address - Street 1:7435 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4403
Practice Address - Country:US
Practice Address - Phone:314-961-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016173163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis