Healthcare Provider Details

I. General information

NPI: 1922005875
Provider Name (Legal Business Name): PAMELA JEAN EATON CRNP-A MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 GREEN VALLEY ROAD
MONROVIA MD
21770
US

IV. Provider business mailing address

4202 GREEN VALLEY ROAD
MONROVIA MD
21770
US

V. Phone/Fax

Practice location:
  • Phone: 301-865-4484
  • Fax: 240-720-0360
Mailing address:
  • Phone: 301-865-4484
  • Fax: 240-720-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR050640
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: