| Provider / Organization | NPI | Date Certified |
|---|---|---|
| WENDY PHREUD EDMOND | 1013458561 | 2017-03-16 |
Wendy Phreud Edmond is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1013458561. Registration indicates Wendy Phreud Edmond is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Gerontology, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Gerontology, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Acute Care, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Acute Care, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Acute Care, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Acute Care, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, ) Access to Adult/Geriatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Acute Care, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Acute Care, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mr. Wendy Phreud Edmond AC-AGNP |
| Practice Office Address | 1111 RONALD REAGAN PKWY AVON, IN US |
| Practice Office Telephone | 3172172888 |
| Practice Office Fax | 3179623916 |
| Mailing Address | 250 N SHADELAND AVE INDIANAPOLIS, IN 462194959 US |
| Address | City / State | Phone / Fax |
|---|---|---|
| 8745 N Wickham Rd | Melbourne, FL 329405997 | 3214349230 |
| 1055 N Curtis Rd | Boise, ID 837061309 | 2083022000 / 2083022055 |
| 1111 Ronald Reagan Pkwy | Avon, IN 461237085 | 3172172888 / 3179623916 |
| 3500 Washington St Apt 208 | Hollywood, FL 330218274 | 7862903485 |
| Direct Messaging Address [] | [email protected] | |
| Direct Messaging Address [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 363LG0600X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Gerontology All Other Specialties & Provider Types Nurse Practitioner Gerontology Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 71013924A
IN |
| 363LA2100X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Acute Care All Other Specialties & Provider Types Nurse Practitioner Acute Care Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 64577
NM |
| 363LA2100X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Acute Care All Other Specialties & Provider Types Nurse Practitioner Acute Care Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | APRN9336037
FL |
| 363LA2100X | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Acute Care All Other Specialties & Provider Types Nurse Practitioner Acute Care Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 73900
ID |
| 023103400 | MEDICAID | FL | |
| OD206 | OTHER | FL | MEDICARE HF |
| 267030310 | OTHER | IN | MEDICARE PTAN |
| 300076966 | MEDICAID | IN |