MEDICARE: MRS. MARSHA FAISON EDWARDS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	0024078221	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1902891005	OTHER	VA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1902891005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARSHA FAISON EDWARDS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 877
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23439-0877
Country	:	US
Telephone Number	:	757-934-9334
Fax Number	:	757-923-9648

Provider Business Practice Location Address
First Line	:	2000 MEADE PKWY
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4259
Country	:	US
Telephone Number	:	757-934-9334
Fax Number	:	757-923-9648

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/10/2020

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