Provider Demographics
NPI:1457080681
Name:EDWARDS, STEPHANIE ELAINE
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 CHECKER DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5048
Mailing Address - Country:US
Mailing Address - Phone:618-823-7800
Mailing Address - Fax:
Practice Address - Street 1:2104 CHECKER DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5048
Practice Address - Country:US
Practice Address - Phone:618-823-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program