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General NPI Number Information
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NPI Number | 1306456884
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Entity Type | Individual
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Provider Name | ALLICIA EDOSA NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2020
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1350 CONNECTICUT AVE NW STE 1250
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City | WASHINGTON
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State | DC
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Zip | 20036-1728
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Country | US
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Telephone | 202-627-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 115 CARRIAGE LAKE DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6287
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN264232
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5019317
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1115651
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP500003934
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License Number State | DC
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