Healthcare Provider Details

I. General information

NPI: 1881431955
Provider Name (Legal Business Name): DUSTIN EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

IV. Provider business mailing address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4600
  • Fax: 212-305-7439
Mailing address:
  • Phone: 212-305-4600
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number765177
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR25633800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number25NJ15126700
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: