Provider Demographics
NPI:1578695300
Name:EATON, KRISTINA M (LMP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:EATON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10071 NE SOUTH BEACH DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-354-2635
Mailing Address - Fax:206-780-7816
Practice Address - Street 1:730 ERICKSEN
Practice Address - Street 2:#116
Practice Address - City:BAINBRIDGE IS
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-354-2635
Practice Address - Fax:206-780-7816
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6140EAOtherREGENCE BLUE SHIELD