MEDICARE: MS. LIANNA MARIE EDWARDS FNP

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	363LF0000X	Family Nurse Practitioner	480031	CA
2	363L00000X	Nurse Practitioner	6271	CA

General Provider Information

NPI Number	:	1851393524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIANNA MARIE EDWARDS FNP

Provider Business Mailing Address
First Line	:	1001 RIVERSIDE AVE
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-5134
Country	:	US
Telephone Number	:	916-746-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 EUREKA RD
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3027
Country	:	US
Telephone Number	:	916-784-4000
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/03/2022

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