MEDICARE: EDNA EARL

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	163W00000X	Registered Nurse	0001091964	VA

General Provider Information

NPI Number	:	1669193074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA EARL

Provider Business Mailing Address
First Line	:	900 GRANBY ST STE 102
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2531
Country	:	US
Telephone Number	:	757-763-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 GRANBY ST STE 102
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2531
Country	:	US
Telephone Number	:	757-763-9244
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “ EDNA EARL ” Practice Location

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