Provider Demographics
NPI:1467547505
Name:EDWARDS, MAUREEN DAWN CAROL (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:DAWN CAROL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4446
Mailing Address - Fax:817-810-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-3953
Practice Address - Fax:682-885-7445
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604584363LP0200X, 363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288190601Medicaid
TX288190602OtherCSHCN
TXB144225Medicare PIN