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General NPI Number Information
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NPI Number | 1629400064
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Entity Type | Individual
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Provider Name | LAURA GREEN EATON FNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 3210 BRISTOL HWY
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1552
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Country | US
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Telephone | 423-926-2358
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 E OAKLAND AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1843
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Country | US
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Telephone | 423-926-2358
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Fax | 423-926-2680
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 17719
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License Number State | TN
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