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NPI Code Detail

MEDICARE: MR. CLARENCE JEP EDWARDS ARNP

MEDICARE: MR. CLARENCE JEP EDWARDS ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseN31979ID
2363LF0000XFamily Nurse PractitionerNURRNLIC38969MT
3363LF0000XFamily Nurse PractitionerNP667AID
4363LF0000XFamily Nurse PractitionerAP30006781WA

General Provider Information

NPI Number : 1053307710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLARENCE JEP EDWARDS ARNP
Provider Business Mailing Address
First Line : 820 N CHELAN AVE
Second Line :
City : WENATCHEE
State : WA
Zip : 98801-2028
Country : US
Telephone Number : 509-663-8711
Fax Number :
Provider Business Practice Location Address
First Line : 916 KOALA DR
Second Line :
City : OMAK
State : WA
Zip : 98841-9759
Country : US
Telephone Number : 509-663-8711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 07/31/2019

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