Healthcare Provider Details

I. General information

NPI: 1124250709
Provider Name (Legal Business Name): LISA EDWARDS WHNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E GRAND RIVER AVE STE 2
BRIGHTON MI
48116-1513
US

IV. Provider business mailing address

315 E GRAND RIVER AVE STE 2
BRIGHTON MI
48116-1513
US

V. Phone/Fax

Practice location:
  • Phone: 248-982-3548
  • Fax: 810-775-1105
Mailing address:
  • Phone: 248-982-3548
  • Fax: 810-775-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704200888
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704200888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: