Healthcare Provider Details

I. General information

NPI: 1720590409
Provider Name (Legal Business Name): ASHLEY LANE EDEN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 CHEROKEE RD
ALEXANDER CITY AL
35010-3437
US

IV. Provider business mailing address

2175 ASHLEY CT
AUBURN AL
36830-1461
US

V. Phone/Fax

Practice location:
  • Phone: 256-234-5021
  • Fax:
Mailing address:
  • Phone: 256-348-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1-142559
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: