Individual
DR. ALICE AUDREY EATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3434 12TH AVE NE, OLYMPIA, WA 98506-5175
(360) 413-8364
(360) 413-8491
Mailing address
8079 SW SACAJAWEA WAY, WILSONVILLE, OR 97070-6428
(503) 784-2490
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD 00030157
WA
208000000X
Pediatrics Physician
Primary
MD16709
OR
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
MD 00030157
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021993008
BLUE CROSS
OR
05
—
036181
—
OR
01
—
93112982997006A008
TRI WEST
—
01
—
F15106
PROVIDENCE HEALTH PLAN
OR
Enumeration date
05/01/2006
Last updated
06/27/2023
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