Provider Demographics
NPI:1447730726
Name:EDENFIELD, ALLISON (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:304 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2812
Mailing Address - Country:US
Mailing Address - Phone:914-497-9694
Mailing Address - Fax:
Practice Address - Street 1:1133 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8307
Practice Address - Country:US
Practice Address - Phone:646-888-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily