Provider Demographics
NPI:1336423896
Name:EATON, MICHAEL WAYNE JR (FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:EATON
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27818 WILD BLOOM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-1437
Mailing Address - Country:US
Mailing Address - Phone:830-331-8585
Mailing Address - Fax:
Practice Address - Street 1:1430 S MAIN ST
Practice Address - Street 2:SUITE NUMBER 111
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3332
Practice Address - Country:US
Practice Address - Phone:830-331-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily