MEDICARE: MARISSA LAYNE EATON CRNP

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	363LA2100X	Acute Care Nurse Practitioner	SP018741	PA

General Provider Information

NPI Number	:	1619465507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LAYNE EATON CRNP

Provider Business Mailing Address
First Line	:	5871 NEWPORT RD
Second Line	:
City	:	CLARKSBURG
State	:	PA
Zip	:	15725-7542
Country	:	US
Telephone Number	:	724-840-1912
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BROOKS LN STE 180
Second Line	:
City	:	JEFFERSON HILLS
State	:	PA
Zip	:	15025-3769
Country	:	US
Telephone Number	:	412-469-3600
Fax Number	:

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

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	11/14/2023

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