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General NPI Number Information
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NPI Number | 1588763007
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Entity Type | Individual
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Provider Name | GINA LYNN EDISON NP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 111 HUNDERTMARK RD
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City | CHASKA
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State | MN
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Zip | 55318-4551
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Country | US
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Telephone | 952-556-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 560 SOUTH MAPLE ST SUITE 130
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City | WACONIA
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State | MN
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Zip | 55387
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Country | US
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Telephone | 952-856-4003
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 128639
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License Number State | WI
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