Provider Demographics
NPI:1487673075
Name:EDWARDS, MICHELE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:EDWARDS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:156 BOOMER COMMUNITY CENTER RD.
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606-0238
Mailing Address - Country:US
Mailing Address - Phone:336-921-2273
Mailing Address - Fax:336-921-2405
Practice Address - Street 1:156 BOOMER COMMUNITY CENTER RD
Practice Address - Street 2:
Practice Address - City:BOOMER
Practice Address - State:NC
Practice Address - Zip Code:28606-9199
Practice Address - Country:US
Practice Address - Phone:336-921-2273
Practice Address - Fax:336-921-2405
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant