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NPI Code Detail

MEDICARE: ELISA EDGERTON FNP

MEDICARE: ELISA EDGERTON FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5006526NC

General Provider Information

NPI Number : 1346678174
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA EDGERTON FNP
Provider Business Mailing Address
First Line : 2832 BUMBLE BEE DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-0361
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1142 N BROOME ST
Second Line :
City : WAXHAW
State : NC
Zip : 28173-9378
Country : US
Telephone Number : 704-843-4680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2013
Last Update Date : 10/14/2013

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Directions to “ ELISA EDGERTON FNP” Practice Location

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