Basic Information
| Provider Information | |||||||||
| NPI: | 1699727263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EATON | ||||||||
| FirstName: | RAINA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035702006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 59 PAGE HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522900 | ||||||||
| FaxNumber: | 6037523727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0554682303 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 795908 | 01 | MVP HEALTHCARE | OTHER | 23YP10095NH01 | 01 | NH | ANTHEM INSURANCE | OTHER | 30344188 | 05 | NH | MEDICAID | 0554682303 | 01 | NH | STATE LICENSE # | OTHER | ME1377161 | 01 | FEDERAL DEA # | OTHER | 3071900 | 05 | NH | MEDICAID |