Healthcare Provider Details

I. General information

NPI: 1003445693
Provider Name (Legal Business Name): MICHELLE EDWARDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 11/27/2023
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH FRESNO STREET, SUITE 370
FRESNO CA
93701
US

IV. Provider business mailing address

215 NORTH FRESNO STREET, SUITE 370
FRESNO CA
93701
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4543
  • Fax: 559-459-1524
Mailing address:
  • Phone: 559-459-4543
  • Fax: 559-459-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number836096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: