Healthcare Provider Details

I. General information

NPI: 1275652042
Provider Name (Legal Business Name): PAMELA LEA EDENS RN MS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GREENFIELD RD #134 RED MOUNTAIN FAMILY MEDICINE
MESA AZ
85205
US

IV. Provider business mailing address

1635 N GREENFIELD RD #134 RED MOUNTAIN FAMILY MEDICINE
MESA AZ
85205
US

V. Phone/Fax

Practice location:
  • Phone: 480-854-7123
  • Fax: 480-854-7627
Mailing address:
  • Phone: 480-854-7123
  • Fax: 480-854-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN033497
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: