Healthcare Provider Details

I. General information

NPI: 1801205950
Provider Name (Legal Business Name): SUSAN EDGLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 08/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 S HARLAN ST
LITTLETON CO
80123-0898
US

IV. Provider business mailing address

5653 S HARLAN ST
LITTLETON CO
80123-0898
US

V. Phone/Fax

Practice location:
  • Phone: 973-907-4751
  • Fax:
Mailing address:
  • Phone: 973-907-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1625768
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: