Healthcare Provider Details

I. General information

NPI: 1659092971
Provider Name (Legal Business Name): EDEN LEHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 32ND AVE S STE 103
GRAND FORKS ND
58201-6509
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 701-792-6700
  • Fax: 701-757-0765
Mailing address:
  • Phone: 602-248-8886
  • Fax: 480-687-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL17142
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: