Provider Demographics
NPI:1922005875
Name:EATON, PAMELA JEAN (CRNP-A MSN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:EATON
Suffix:
Gender:F
Credentials:CRNP-A MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 GREEN VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770
Mailing Address - Country:US
Mailing Address - Phone:301-865-4484
Mailing Address - Fax:240-720-0360
Practice Address - Street 1:4202 GREEN VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:MD
Practice Address - Zip Code:21770
Practice Address - Country:US
Practice Address - Phone:301-865-4484
Practice Address - Fax:240-720-0360
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR050640363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4043448-00Medicaid
MDR050640OtherNURSE PRACTITIONER
MDME-0578813OtherDEA
MDME-0578813OtherDEA
MD4043448-00Medicaid