Provider Demographics
NPI:1508197666
Name:EATON, CHAMAGNE JANAE (CST)
Entity Type:Individual
Prefix:
First Name:CHAMAGNE
Middle Name:JANAE
Last Name:EATON
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 S SHORTLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-8610
Mailing Address - Country:US
Mailing Address - Phone:208-343-2086
Mailing Address - Fax:
Practice Address - Street 1:3630 E LOUISE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7975
Practice Address - Country:US
Practice Address - Phone:208-377-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90956246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist