Basic Information
| Provider Information | |||||||||
| NPI: | 1174292429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 SOUTHPARK BLVD | ||||||||
| Address2: | |||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238343609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045047980 | ||||||||
| FaxNumber: | 8045545387 | ||||||||
| Practice Location | |||||||||
| Address1: | 524 SOUTHPARK BLVD | ||||||||
| Address2: | |||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238343609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045047980 | ||||||||
| FaxNumber: | 8045545387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2021 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0024182391 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.