Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301006308 | MI |
Y | 103T00000X | Psychologist | 6301006308 | MI |
NPI | 1013073121 |
---|---|
Provider Name | Dr. Sheila Joyce Eaton |
First Address | Warren, MI 48093-5527 |
Second Address | Warren, MI 48093-5527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0E00067 | BLUECROSSBLUE SHIELD (01) | MI |
103641 | VALUE OPTIONS (01) | MI |
R67267 | (02) | MI |