Healthcare Provider Details

I. General information

NPI: 1033427588
Provider Name (Legal Business Name): ANDREA MARIE EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 LOFTIS BLVD SUITE 100
NEWPORT NEWS VA
23606-3069
US

IV. Provider business mailing address

5900 LAKE WRIGHT DR
NORFOLK VA
23502-1871
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-9400
  • Fax: 757-873-9420
Mailing address:
  • Phone: 757-466-8683
  • Fax: 757-466-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: