Healthcare Provider Details

I. General information

NPI: 1083919666
Provider Name (Legal Business Name): PAMELA RENEE EDMOND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28175 HAGGERTY RD
NOVI MI
48377-2903
US

IV. Provider business mailing address

28175 HAGGERTY RD
NOVI MI
48377-2903
US

V. Phone/Fax

Practice location:
  • Phone: 248-638-0508
  • Fax:
Mailing address:
  • Phone: 248-636-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704209077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: