MEDICARE: RONTRAY EDWARDS

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	171M00000X	Case Manager/Care Coordinator
2	174400000X	Specialist
3	104100000X	Social Worker	6889	ND

General Provider Information

NPI Number	:	1669329843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONTRAY EDWARDS

Provider Business Mailing Address
First Line	:	1202 28TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-8700
Country	:	US
Telephone Number	:	701-280-9545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 28TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-8700
Country	:	US
Telephone Number	:	701-280-9545
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ RONTRAY EDWARDS ” Practice Location

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