=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649081506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE M EDWARDS CRNP, MSN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 HIGHLAND AVE
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331-2297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-988-0000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 HIGHLAND AVE
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331-2297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-988-0000
-----------------------------------------------------
Fax | 717-782-5716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP031909
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------