Provider Demographics
NPI:1477626380
Name:EDWARDS, CHARLOTTE ELISABETH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ELISABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 S CAROUSEL CIR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9003
Mailing Address - Country:US
Mailing Address - Phone:843-291-1557
Mailing Address - Fax:
Practice Address - Street 1:9639 S CAROUSEL CIR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9003
Practice Address - Country:US
Practice Address - Phone:843-291-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 951302367500000X
GARN004886 CRNA367500000X
SC3432367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302273100Medicaid
GA556828024BMedicaid
SCAN0238Medicaid
GA556828024CMedicaid
GA556828024CMedicaid
FL302273100Medicaid
SCAN0238Medicaid