Provider Demographics
NPI:1225503030
Name:DEERING, EDWARD (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:DEERING
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ROYAL ANNE LN APT 304
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7821
Mailing Address - Country:US
Mailing Address - Phone:954-778-3842
Mailing Address - Fax:
Practice Address - Street 1:300 KEISLER DR STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7083
Practice Address - Country:US
Practice Address - Phone:919-233-0059
Practice Address - Fax:919-233-0343
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDEER-R945W3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner