Basic Information
| Provider Information | |||||||||
| NPI: | 1649712084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EATON | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 FOUNDERS ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604239764 | ||||||||
| FaxNumber: | 8604233115 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 FOUNDERS ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WILLIMANTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062262048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604239764 | ||||||||
| FaxNumber: | 8604233115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2016 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 4158 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 364SA2200X | 4158 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.