Healthcare Provider Details

I. General information

NPI: 1104340710
Provider Name (Legal Business Name): MELINDA JANE EASTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 EMERSON AVENUE GLO
GLOUCESTER MA
01930
US

IV. Provider business mailing address

37 FRIEND STREET ELEMENT CARE INC
LYNN MA
01902
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-7375
  • Fax: 978-283-1588
Mailing address:
  • Phone: 781-715-6608
  • Fax: 781-715-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN229450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: