Provider Demographics
NPI:1063569408
Name:EATON, PAMELA ANN (ANP-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:EATON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OHIO ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1191
Mailing Address - Country:US
Mailing Address - Phone:585-798-3345
Mailing Address - Fax:
Practice Address - Street 1:100 OHIO ST
Practice Address - Street 2:SUITE C
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1191
Practice Address - Country:US
Practice Address - Phone:585-798-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303784-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health