Healthcare Provider Details

I. General information

NPI: 1376276105
Provider Name (Legal Business Name): LAUREN LEIGH EDWARDS AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

4300 OXBRIDGE RD
NORTH CHESTERFIELD VA
23236-1042
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 804-839-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024184640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: