Provider Demographics
NPI:1609123843
Name:EATON, TERESA R (BA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:EATON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 COMMERCIAL WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4755
Mailing Address - Country:US
Mailing Address - Phone:307-389-6579
Mailing Address - Fax:
Practice Address - Street 1:2620 COMMERCIAL WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4755
Practice Address - Country:US
Practice Address - Phone:307-389-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator