Healthcare Provider Details

I. General information

NPI: 1205317005
Provider Name (Legal Business Name): EMMA MARIE EDGAR AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LANG AVE NE STE 100
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-2574
  • Fax: 505-883-0725
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP138625
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS-54439
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: