Healthcare Provider Details

I. General information

NPI: 1336325166
Provider Name (Legal Business Name): MICHAEL S EDWARDS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 THOMPSON RD
COOS BAY OR
97420-2040
US

IV. Provider business mailing address

1957 THOMPSON RD
COOS BAY OR
97420-2040
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-4429
  • Fax: 541-267-5247
Mailing address:
  • Phone: 541-267-4429
  • Fax: 541-267-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: