Provider Demographics
NPI:1821812819
Name:EATON, MEGAN MARIE
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:EATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 113TH AVE NE STE 210
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6950
Mailing Address - Country:US
Mailing Address - Phone:425-403-5765
Mailing Address - Fax:
Practice Address - Street 1:12220 113TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6950
Practice Address - Country:US
Practice Address - Phone:425-403-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program