Provider Demographics
NPI:1568621662
Name:EON, SELENA B (ND)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:B
Last Name:EON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50266
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98015-0266
Mailing Address - Country:US
Mailing Address - Phone:425-780-7019
Mailing Address - Fax:
Practice Address - Street 1:12727 NORTHUP WAY STE 20
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1917
Practice Address - Country:US
Practice Address - Phone:425-780-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60011961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine