MEDICARE: OLIVIA GRACE EATON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN768302	PA

General Provider Information

NPI Number	:	1447105515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA GRACE EATON RN

Provider Business Mailing Address
First Line	:	555 FOREST INN RD
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-5254
Country	:	US
Telephone Number	:	570-664-4065
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 FOREST INN RD
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-5254
Country	:	US
Telephone Number	:	570-664-4065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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