Healthcare Provider Details

I. General information

NPI: 1891874996
Provider Name (Legal Business Name): DAVID WAYNE EDGE L.AC., O.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 US HIGHWAY 395 N SUITE 230
GARDNERVILLE NV
89410-5265
US

IV. Provider business mailing address

396 RUSSELL WAY
GARDNERVILLE NV
89460-6503
US

V. Phone/Fax

Practice location:
  • Phone: 775-783-4930
  • Fax: 775-783-7629
Mailing address:
  • Phone: 775-781-3465
  • Fax: 775-783-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1031
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: