MEDICARE: LADONNA EDWARDS MSN,CRNP

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	363L00000X	Nurse Practitioner	1081026	AL

General Provider Information

NPI Number	:	1609233964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADONNA EDWARDS MSN,CRNP

Provider Business Mailing Address
First Line	:	1090 SHADES CREST RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-1906
Country	:	US
Telephone Number	:	205-212-8215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 HIGHWAY 280 S STE 212
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2468
Country	:	US
Telephone Number	:	205-878-4368
Fax Number	:

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

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	07/21/2020

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