Provider Demographics
NPI:1437452760
Name:EDGAR, MILLICENT MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:MARIE
Last Name:EDGAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 MELFORD BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4411
Mailing Address - Country:US
Mailing Address - Phone:202-681-3533
Mailing Address - Fax:
Practice Address - Street 1:16701 MELFORD BLVD
Practice Address - Street 2:STE 400
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4411
Practice Address - Country:US
Practice Address - Phone:202-681-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR137572OtherLICENSE