Provider Demographics
NPI:1699384826
Name:ASTREMONT, EDRINE
Entity Type:Individual
Prefix:
First Name:EDRINE
Middle Name:
Last Name:ASTREMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MALDEN
Mailing Address - Street 2:
Mailing Address - City:MASSACHUSETTS
Mailing Address - State:NY
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:617-543-9991
Mailing Address - Fax:
Practice Address - Street 1:414 MALDEN
Practice Address - Street 2:
Practice Address - City:MASSACHUSETTS
Practice Address - State:NY
Practice Address - Zip Code:02176
Practice Address - Country:US
Practice Address - Phone:617-543-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY776670163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse