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General NPI Number Information
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NPI Number | 1912356494
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Entity Type | Individual
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Provider Name | NATHAN TYLER EDWARDS CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 251 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-2908
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Country | US
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Telephone | 256-658-9848
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 W SCHUBERT AVE APT. 1-O
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City | CHICAGO
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State | IL
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Zip | 60647-1320
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Country | US
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Telephone | 256-658-9848
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 186574
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 209.014949
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 041.442743
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License Number State | IL
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