Provider Demographics
NPI:1003907957
Name:EDENFIELD, LORI DAWN (ARNP BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DAWN
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:ARNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428
Mailing Address - Country:US
Mailing Address - Phone:850-638-3400
Mailing Address - Fax:850-638-9611
Practice Address - Street 1:1410 BRICKYARD RD
Practice Address - Street 2:SAMUEL E WARD MD PL
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428
Practice Address - Country:US
Practice Address - Phone:850-638-3400
Practice Address - Fax:850-638-9611
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3139042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y9743YMedicare ID - Type Unspecified
P23195Medicare UPIN