Individual
JEAN A EDMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
23829 LITTLE MACK AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
(586) 773-1600
Mailing address
23829 LITTLE MACK AVE, SUITE 100, SAINT CLAIR SHORES, MI 48080-1186
(586) 773-1300
(586) 773-1600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704215622
MI
363L00000X
Nurse Practitioner
JE215622
MI
363LF0000X
Family Nurse Practitioner
Primary
4704215622
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4761826
—
MI
01
—
5008605420
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/01/2006
Last updated
11/08/2021
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