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General NPI Number Information
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NPI Number | 1073101499
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Entity Type | Individual
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Provider Name | BETTY ANN EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 01/03/2021
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 300 SKILLMAN AVE
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City | BROOKLYN
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State | NY
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Zip | 11211-1607
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Country | US
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Telephone | 347-377-5913
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Fax | 718-599-2840
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Provider Business Mailing Address
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Address Line | 440 BELMONT BAY DR UNIT 310
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5452
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Country | US
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Telephone | 703-489-7041
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F404686-01
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License Number State | NY
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