Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 324177-21 | MO |
NPI | 1023237930 |
---|---|
Provider Name | Mrs. Leann E Eaton |
First Address | Saint Louis, MO 63129-5623 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |