Provider Demographics
NPI:1740595354
Name:EATON, ERICA LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYN
Last Name:EATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:LYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4016
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-3700
Mailing Address - Country:US
Mailing Address - Phone:970-642-8413
Mailing Address - Fax:970-641-9017
Practice Address - Street 1:707 N IOWA ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2229
Practice Address - Country:US
Practice Address - Phone:970-642-8413
Practice Address - Fax:970-641-9017
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003011207Q00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ151649Medicare PIN
AZZ151649Medicare PIN