Provider Demographics
NPI:1013139955
Name:EDSON, ANN MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:EDSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRIAN WAY
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-0000
Mailing Address - Country:US
Mailing Address - Phone:978-298-5323
Mailing Address - Fax:
Practice Address - Street 1:2 BRIAN WAY
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-0000
Practice Address - Country:US
Practice Address - Phone:978-298-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340239363LG0600X
MA272452363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS 87728Medicare UPIN