Provider Demographics
NPI:1770003832
Name:EATON, ALICE REGINA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:REGINA
Last Name:EATON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:REGINA
Other - Last Name:EMMANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 LONGWATER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1620
Mailing Address - Country:US
Mailing Address - Phone:781-792-4136
Mailing Address - Fax:781-878-6750
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-624-8000
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant