Provider Demographics
NPI:1720308349
Name:EDMUNDSON, ADRIANNE NETTERVILLE (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:NETTERVILLE
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 AIRLINE HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4272
Mailing Address - Country:US
Mailing Address - Phone:225-402-4215
Mailing Address - Fax:225-402-4279
Practice Address - Street 1:16260 AIRLINE HWY
Practice Address - Street 2:SUITE F
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4272
Practice Address - Country:US
Practice Address - Phone:800-600-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206182207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA475179ZTEZMedicare PIN