Provider Demographics
NPI:1649712084
Name:EATON, CHERYL LEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEE
Last Name:EATON
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:5 FOUNDERS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2048
Mailing Address - Country:US
Mailing Address - Phone:860-423-9764
Mailing Address - Fax:860-423-3115
Practice Address - Street 1:5 FOUNDERS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2048
Practice Address - Country:US
Practice Address - Phone:860-423-9764
Practice Address - Fax:860-423-3115
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT4158363LP2300X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health