Provider Demographics
NPI:1952770380
Name:EAMON, MARIE CHRIS
Entity Type:Individual
Prefix:
First Name:MARIE CHRIS
Middle Name:
Last Name:EAMON
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 1:30600 TELEGRAPH RD STE 1130
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4531
Mailing Address - Country:US
Mailing Address - Phone:248-621-0370
Mailing Address - Fax:248-621-0371
Practice Address - Street 1:30600 TELEGRAPH RD STE 1130
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-622-6195
Practice Address - Fax:313-794-8790
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG0915078363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care