MEDICARE: WENDY EDGIN

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
1	174H00000X	Health Educator	8661	SC

General Provider Information

NPI Number	:	1134679376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY EDGIN

Provider Business Mailing Address
First Line	:	158 AYLESBURY RD
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-5717
Country	:	US
Telephone Number	:	843-813-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 BEN SAWYER BLVD STE D
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5533
Country	:	US
Telephone Number	:	843-813-4105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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