Provider Demographics
NPI:1164769519
Name:MCKINNEY, EDGAR CARL (CRT)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:CARL
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8587 S DEERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8006
Mailing Address - Country:US
Mailing Address - Phone:262-880-5983
Mailing Address - Fax:
Practice Address - Street 1:8587 S DEERWOOD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8006
Practice Address - Country:US
Practice Address - Phone:262-880-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3384-0282278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care