1154307189 NPI number — MRS. LORI ANN EDGAR MSN FNP-BC

Table of content: MRS. LORI ANN EDGAR MSN FNP-BC (NPI 1154307189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154307189 NPI number — MRS. LORI ANN EDGAR MSN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDGAR
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154307189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1938 CHARLIE HALL BLVD
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29414-6099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-402-0227
Provider Business Mailing Address Fax Number:
842-402-0232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1938 CHARLIE HALL BLVD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29414-6099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-402-0227
Provider Business Practice Location Address Fax Number:
843-402-0232
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APN 2541 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP0875 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00638337 . This is a "RAILROAD MEDICARE ID-PRIOR TO 5/1/09" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: P00820369 . This is a "RAILROAD MEDICARE ID-RSFPN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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