Provider Demographics
NPI:1003846072
Name:EDSON, CATHY (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:EDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:AYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4317
Mailing Address - Fax:
Practice Address - Street 1:218A SUNSET RD
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-3030
Practice Address - Fax:609-835-3063
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN048298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8407703Medicaid
NJ500028976Medicare PIN
P23283Medicare UPIN
NJ8407703Medicaid