Healthcare Provider Details

I. General information

NPI: 1922557156
Provider Name (Legal Business Name): ASHLEY MARIE BERRY MCEDRISS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 WATER ST STE 102B
WAKEFIELD MA
01880-3038
US

IV. Provider business mailing address

269 UNION ST
LYNN MA
01901-1314
US

V. Phone/Fax

Practice location:
  • Phone: 781-587-2974
  • Fax: 781-587-2987
Mailing address:
  • Phone: 781-581-3900
  • Fax: 781-598-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2264069
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: