Provider Demographics
NPI:1508014580
Name:EDISON, NINA STAFFORD (RN)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:STAFFORD
Last Name:EDISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NINA
Other - Middle Name:STAFFORD
Other - Last Name:EDISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2710 S MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7916
Mailing Address - Country:US
Mailing Address - Phone:704-636-2900
Mailing Address - Fax:704-637-2800
Practice Address - Street 1:2710 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-7916
Practice Address - Country:US
Practice Address - Phone:704-636-2900
Practice Address - Fax:704-637-2800
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC135371163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health