MEDICARE: LISSA EDMOND APN-C

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00627000	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401979	NY

General Provider Information

NPI Number	:	1740642503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSA EDMOND APN-C

Provider Business Mailing Address
First Line	:	PO BOX 7158
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-7158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 SCOTCH RD
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-2529
Country	:	US
Telephone Number	:	973-358-5558
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	08/06/2021

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Directions to “ LISSA EDMOND APN-C” Practice Location

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