Provider Demographics
NPI:1679746374
Name:EATON, ALICIA R (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:R
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 1:1050 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:SEAMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45679-9793
Mailing Address - Country:US
Mailing Address - Phone:937-217-3996
Mailing Address - Fax:
Practice Address - Street 1:1050 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-9793
Practice Address - Country:US
Practice Address - Phone:937-217-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN140003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse