Individual
JAMIE F EDENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 243-8405
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 243-8405
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2009-0028
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96972351
—
NM
Enumeration date
02/13/2008
Last updated
07/10/2014
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