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General NPI Number Information
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NPI Number | 1922782259
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Entity Type | Individual
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Provider Name | KATRINA C EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 155 N QUEEN ST
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City | MARTINSBURG
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State | WV
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Zip | 25401-3311
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Country | US
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Telephone | 305-202-4854
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Fax | 304-305-1597
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Provider Business Mailing Address
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Address Line | 21 COMPASSION DR
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City | MARTINSBURG
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State | WV
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Zip | 25405-3056
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Country | US
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Telephone | 304-886-6921
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 31384
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License Number State | WV
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