Healthcare Provider Details

I. General information

NPI: 1821185489
Provider Name (Legal Business Name): EDWIN HAROLD WALDROP JR. N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W COURT ST
RUTHERFORDTON NC
28139-2805
US

IV. Provider business mailing address

PO BOX 878
RUTHERFORDTON NC
28139-0878
US

V. Phone/Fax

Practice location:
  • Phone: 828-287-7806
  • Fax: 828-287-0004
Mailing address:
  • Phone: 828-287-7806
  • Fax: 828-287-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0050-02616
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: