MEDICARE: PRINCESS TEMISAN EDEMA-SILLO BSN, RN

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	163W00000X	Registered Nurse	347988	NC

General Provider Information

NPI Number	:	1750224564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS TEMISAN EDEMA-SILLO BSN, RN

Provider Business Mailing Address
First Line	:	1413 PLEASANT GARDEN LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6407
Country	:	US
Telephone Number	:	919-720-6734
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 BLUE RIDGE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-3105
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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