Healthcare Provider Details

I. General information

NPI: 1578301115
Provider Name (Legal Business Name): STEPHANIE EDGAR DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

420 COX ST
SIMPSONVILLE SC
29681-2513
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4220
  • Fax: 541-706-5925
Mailing address:
  • Phone: 479-438-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number242660
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-034291
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28743
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: