Provider Demographics
NPI:1134679376
Name:EDGIN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:EDGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 AYLESBURY RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5717
Mailing Address - Country:US
Mailing Address - Phone:843-813-4105
Mailing Address - Fax:
Practice Address - Street 1:1537 BEN SAWYER BLVD STE D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5533
Practice Address - Country:US
Practice Address - Phone:843-813-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8661174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator