MEDICARE: LAUREL D EDINBURGH CPNP

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	1215	MN
2	363LP0200X	Pediatric Nurse Practitioner	R1447989	MN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R144789-9	MN

General Provider Information

NPI Number	:	1871552323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL D EDINBURGH CPNP

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W STE 229N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1902
Country	:	US
Telephone Number	:	651-645-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1716 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2817
Country	:	US
Telephone Number	:	612-719-5392
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/21/2024

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