Provider Demographics
NPI:1497336416
Name:EDGECOMBE, HARCOURT PRINCE (RN)
Entity Type:Individual
Prefix:
First Name:HARCOURT
Middle Name:PRINCE
Last Name:EDGECOMBE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17115 IH 35S
Mailing Address - Street 2:SCHERTZ, TEXAS
Mailing Address - City:SCHERTZ
Mailing Address - State:AA
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:210-539-0735
Mailing Address - Fax:210-539-2107
Practice Address - Street 1:17115 IH 35S
Practice Address - Street 2:SCHERTZ, TEXAS
Practice Address - City:SCHERTZ
Practice Address - State:AA
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-539-0735
Practice Address - Fax:210-539-2107
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619880163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty