Healthcare Provider Details

I. General information

NPI: 1164405619
Provider Name (Legal Business Name): REBECCA LYNN EDWARDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CRESCENT STREET MIDDLESEX HOSPITAL HOSPICE AND PALLIATIVE CARE
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

28 CRESCENT STREET MIDDLESEX HOSPITAL HOSPICE AND PALLIATIVE CARE
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-6100
  • Fax:
Mailing address:
  • Phone: 860-358-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2230
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number002230
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: