Healthcare Provider Details

I. General information

NPI: 1992869200
Provider Name (Legal Business Name): WILLIAM F EDWARDS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CHESTNUT ST RALSTON-PENN CENTER
PHILADELPHIA PA
19104-2612
US

IV. Provider business mailing address

3615 CHESTNUT ST RALSTON-PENN CENTER
PHILADELPHIA PA
19104-2612
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2746
  • Fax:
Mailing address:
  • Phone: 215-662-3958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberTP000975H
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: