Provider Demographics
NPI:1700335437
Name:EATON, NANCY ELLEN (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELLEN
Last Name:EATON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 W LAYTON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2600
Mailing Address - Country:US
Mailing Address - Phone:414-242-5468
Mailing Address - Fax:888-724-0875
Practice Address - Street 1:745 N SWOPE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140
Practice Address - Country:US
Practice Address - Phone:317-462-9221
Practice Address - Fax:317-462-3400
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006765A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201412630Medicaid