Healthcare Provider Details

I. General information

NPI: 1750792263
Provider Name (Legal Business Name): MICHEAL EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S MAIN ST
WARRENTON NC
27589-1964
US

IV. Provider business mailing address

108 S MAIN ST
WARRENTON NC
27589-1964
US

V. Phone/Fax

Practice location:
  • Phone: 252-879-0075
  • Fax: 252-879-0073
Mailing address:
  • Phone: 252-879-0075
  • Fax: 252-879-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001232127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: