Provider Demographics
NPI:1003583824
Name:EDMONDS, ASHLEY H (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 BOLDREY DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9654
Mailing Address - Country:US
Mailing Address - Phone:810-429-7859
Mailing Address - Fax:
Practice Address - Street 1:41850 W 11 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1857
Practice Address - Country:US
Practice Address - Phone:810-429-7859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner