Provider Demographics
NPI:1144803990
Name:IDAN, EDNA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:IDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 2ST AVE SOUTH 703 OXFORD HOUSE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-4700
Mailing Address - Country:US
Mailing Address - Phone:615-936-0087
Mailing Address - Fax:615-936-1316
Practice Address - Street 1:1313 2ST AVE SOUTH 703 OXFORD HOUSE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4700
Practice Address - Country:US
Practice Address - Phone:615-936-0087
Practice Address - Fax:615-936-1316
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program