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General NPI Number Information
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NPI Number | 1972983658
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Entity Type | Individual
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Provider Name | LACRYSHA FOREMAN EDMUNDSON RN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1016 TELLIS DR
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City | KNIGHTDALE
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State | NC
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Zip | 27545-8156
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Country | US
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Telephone | 252-363-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 GLENWOOD AVE STE 200
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City | RALEIGH
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State | NC
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Zip | 27612-3857
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Country | US
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Telephone | 252-363-4535
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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 | 221697
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License Number State | NC
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