Provider Demographics
NPI:1225738099
Name:EATON, AYLISH ANN
Entity type:Individual
Prefix:
First Name:AYLISH
Middle Name:ANN
Last Name:EATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9525
Mailing Address - Country:US
Mailing Address - Phone:208-619-9735
Mailing Address - Fax:
Practice Address - Street 1:207 S SUNSET DR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9525
Practice Address - Country:US
Practice Address - Phone:208-619-9735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care