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NPI Code Detail

MEDICARE: STEPHANIE EDGAR DNP

MEDICARE: STEPHANIE EDGAR DNP
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 Nurse242660SC
2363LF0000XFamily Nurse Practitioner209-034291IL
3363LF0000XFamily Nurse Practitioner28743SC

General Provider Information

NPI Number : 1578301115
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE EDGAR DNP
Provider Business Mailing Address
First Line : 420 COX ST
Second Line :
City : SIMPSONVILLE
State : SC
Zip : 29681-2513
Country : US
Telephone Number : 479-438-1764
Fax Number :
Provider Business Practice Location Address
First Line : 1401 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-2315
Country : US
Telephone Number : 779-696-3050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2024
Last Update Date : 06/05/2026

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