Provider Demographics
NPI:1275652042
Name:EDENS, PAMELA LEA (RN MS FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LEA
Last Name:EDENS
Suffix:
Gender:F
Credentials:RN MS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N GREENFIELD RD
Mailing Address - Street 2:#134 RED MOUNTAIN FAMILY MEDICINE
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-854-7123
Mailing Address - Fax:480-854-7627
Practice Address - Street 1:1635 N GREENFIELD RD
Practice Address - Street 2:#134 RED MOUNTAIN FAMILY MEDICINE
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-854-7123
Practice Address - Fax:480-854-7627
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN033497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily