Provider Demographics
NPI:1730186537
Name:EDWARDS, ANN MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:SEDMAK
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:18100 OAKWOOD BLVD STE 213
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-438-7992
Practice Address - Fax:313-438-7990
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517756Medicaid
MI4517756Medicaid
MIOM 98470Medicare UPIN