Edmondson, Jean A

Edmondson, Jean A is an individual health care provider with primary practice located at 23829 Little Mack Ave Suite 100, Saint Clair Shores MI 48080-1186. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Edmondson, Jean A can be contacted via phone (586) 773-1300.

Contact Information

Primary practice address
23829 Little Mack Ave Suite 100 Saint Clair Shores MI 48080-1186
Phone: (586) 773-1300
Fax: (586) 773-1600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X JE215622 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704215622 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4704215622 Michigan

Profile Details

NPI number 1992742753
LBN Legal business name Edmondson, Jean A
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Nov 8th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992742753 NPPES
Michigan Other 5008605420 BLUE CROSS BLUE SHIELD
Michigan MEDICAID 4761826 BLUE CROSS BLUE SHIELD

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