Provider Demographics
NPI:1275815698
Name:EDWARDS, DEANNE S (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 W RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-1716
Mailing Address - Country:US
Mailing Address - Phone:252-257-1904
Mailing Address - Fax:
Practice Address - Street 1:546 W RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-1716
Practice Address - Country:US
Practice Address - Phone:252-257-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005109363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health