MEDICARE: DR. NINA K. EDWARDS MD.

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
1	208600000X	Surgery Physician	017148	ME

General Provider Information

NPI Number	:	1619961067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA K. EDWARDS MD.

Provider Business Mailing Address
First Line	:	12 HIGH ST
Second Line	:	STE. 401
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5767
Fax Number	:	207-795-2732

Provider Business Practice Location Address
First Line	:	12 HIGH ST
Second Line	:	STE. 401
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5767
Fax Number	:	207-795-2732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/11/2021

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