Healthcare Provider Details

I. General information

NPI: 1215860929
Provider Name (Legal Business Name): JUDY EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LILAC DR N STE 140
GOLDEN VALLEY MN
55422-4791
US

IV. Provider business mailing address

2256 144TH LN NE
HAM LAKE MN
55304-6226
US

V. Phone/Fax

Practice location:
  • Phone: 763-465-0500
  • Fax:
Mailing address:
  • Phone: 763-218-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number13943
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: