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General NPI Number Information
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NPI Number | 1427577642
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Entity Type | Individual
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Provider Name | MICHELLE JOSETTE EDWARDS PA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 40910 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4375
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Country | US
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Telephone | 510-252-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 MADERA AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-1604
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Country | US
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Telephone | 832-226-3759
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA64163
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License Number State | CA
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