Provider Demographics
NPI:1265474639
Name:DEDLOW, EDNA ROSELLEN (MSN, PNP-BC)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:ROSELLEN
Last Name:DEDLOW
Suffix:
Gender:F
Credentials:MSN, PNP-BC
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Mailing Address - Street 1:719 GREEN VALLEY RD STE 306
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7026
Mailing Address - Country:US
Mailing Address - Phone:336-275-6470
Mailing Address - Fax:336-275-6474
Practice Address - Street 1:719 GREEN VALLEY RD STE 306
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7026
Practice Address - Country:US
Practice Address - Phone:336-275-6470
Practice Address - Fax:336-275-6474
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC5007053363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1265474639Medicaid
FL301412600Medicaid
FL301412600Medicaid