MEDICARE: DR. RAQUEL MARIA LOUISA EDMONDSON DNP

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	205152	OK

General Provider Information

NPI Number	:	1942031802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAQUEL MARIA LOUISA EDMONDSON DNP

Provider Business Mailing Address
First Line	:	3000 N GRAND BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1818
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 S EASTERN AVE BLDG A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-6035
Country	:	US
Telephone Number	:	405-632-6688
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	10/10/2024

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