Healthcare Provider Details

I. General information

NPI: 1467547505
Provider Name (Legal Business Name): MAUREEN DAWN CAROL EDWARDS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/20/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 US-50 SUITE 201
FAIRFAX VA
22033
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-0900
  • Fax:
Mailing address:
  • Phone: 682-885-4446
  • Fax: 817-810-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number604584
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0021489007
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number604584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: