Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704278463 | MI |
NPI | 1003583824 |
---|---|
Provider Name | Ashley H Edmonds |
First Address | Fenton, MI 48430-9654 |
Second Address | Novi, MI 48375-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2021 |
Last Update Date | 28/08/2021 |