Provider Demographics
NPI:1538139027
Name:EDWARDS, CONNIE I (ARNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:I
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-1108
Mailing Address - Country:US
Mailing Address - Phone:509-877-4111
Mailing Address - Fax:509-877-7349
Practice Address - Street 1:620 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WAPATO
Practice Address - State:WA
Practice Address - Zip Code:98951-1108
Practice Address - Country:US
Practice Address - Phone:509-877-4111
Practice Address - Fax:509-877-7349
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004736363LF0000X, 363L00000X
AKAK 1393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622218Medicaid
WA8851105Medicare ID - Type Unspecified
WA9622218Medicaid