Healthcare Provider Details

I. General information

NPI: 1073335154
Provider Name (Legal Business Name): CHAD ANDREW EDWARDS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 BYRD DR
LOVELAND CO
80538-7198
US

IV. Provider business mailing address

714 W 5TH ST
LOVELAND CO
80537-5318
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-3300
  • Fax: 970-962-4901
Mailing address:
  • Phone: 512-284-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1643259
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: