Individual
MRS. ELIZABETH A EATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1800 N. CAPITOL AVENUE, SUITE E-140, INDIANAPOLIS, IN 46202-1218
(317) 962-2894
(317) 963-5285
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10000464A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000518150
BC/BS PIN
IN
01
—
DF5450
RAILROAD MEDICARE GROUP
—
Enumeration date
06/05/2006
Last updated
01/30/2014
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