Provider Demographics
NPI:1275277691
Name:PRIEST, EDWINA MONET (MT)
Entity Type:Individual
Prefix:MS
First Name:EDWINA
Middle Name:MONET
Last Name:PRIEST
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ROCKWATER WAY
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-9735
Mailing Address - Country:US
Mailing Address - Phone:706-832-8999
Mailing Address - Fax:
Practice Address - Street 1:157 ROCKWATER WAY
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9735
Practice Address - Country:US
Practice Address - Phone:706-832-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist