Provider Demographics
NPI:1205293859
Name:EATON, MELISSA E (FNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:EATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST STE 15
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3753
Mailing Address - Country:US
Mailing Address - Phone:508-660-1666
Mailing Address - Fax:508-660-1667
Practice Address - Street 1:420 MAIN ST STE 15
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081
Practice Address - Country:US
Practice Address - Phone:508-660-1666
Practice Address - Fax:508-660-1667
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily