Healthcare Provider Details

I. General information

NPI: 1851949812
Provider Name (Legal Business Name): MRS. ALLYSON BROOKE EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALLYSON BROOKE GRAF

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FILLMORE ST FL 5
DENVER CO
80206-4916
US

IV. Provider business mailing address

109 STATE ST. 5TH FL
BOSTON MA
02109-2906
US

V. Phone/Fax

Practice location:
  • Phone: 617-505-1520
  • Fax: 617-928-8401
Mailing address:
  • Phone: 617-505-1520
  • Fax: 617-928-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007474
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: