Provider Demographics
NPI:1528551389
Name:EATON, KIRSTEN (LPN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:EATON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 STONE QUARRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:13841
Mailing Address - Country:US
Mailing Address - Phone:607-656-7173
Mailing Address - Fax:
Practice Address - Street 1:128 STONE QUARRY HILL RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE FLATS
Practice Address - State:NY
Practice Address - Zip Code:13841-0215
Practice Address - Country:US
Practice Address - Phone:607-656-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274394-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse