Healthcare Provider Details

I. General information

NPI: 1255356317
Provider Name (Legal Business Name): CAROL LINN EDWARDS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 S OTSEGO AVE
GAYLORD MI
49735-1725
US

IV. Provider business mailing address

806 S OTSEGO AVE
GAYLORD MI
49735-1725
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-7525
  • Fax:
Mailing address:
  • Phone: 989-732-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberL615771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: