Provider Demographics
NPI:1033255369
Name:PEARSALL, EDITH LYNEET (FNP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:LYNEET
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:TART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 PORTERS NECK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8131
Mailing Address - Country:US
Mailing Address - Phone:910-686-1099
Mailing Address - Fax:910-686-4715
Practice Address - Street 1:1013 PORTERS NECK RD STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-686-1099
Practice Address - Fax:910-686-4715
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592170Medicare ID - Type UnspecifiedFNP
NCQ28410Medicare UPIN