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General NPI Number Information
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NPI Number | 1063954923
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Entity Type | Individual
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Provider Name | DAVID DUSTIN EDWARDS CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 1600 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1799
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Country | US
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Telephone | 806-212-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 PLEASANT UNITY RD
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City | LATROBE
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State | PA
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Zip | 15650-5108
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Country | US
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Telephone | 208-220-5660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN664884
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 57362
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License Number State | ID
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