Healthcare Provider Details

I. General information

NPI: 1205818176
Provider Name (Legal Business Name): DIANA L EDENFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 11TH ST STE M106
HERMISTON OR
97838-6941
US

IV. Provider business mailing address

620 NW 11TH ST STE 106
HERMISTON OR
97838-6941
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3801
  • Fax: 541-667-3802
Mailing address:
  • Phone: 541-667-3801
  • Fax: 541-667-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD26673
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: