Provider Demographics
NPI:1558648741
Name:EDGAR, CONNIE (NP C)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:EDGAR
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4094
Mailing Address - Country:US
Mailing Address - Phone:719-587-6800
Mailing Address - Fax:719-587-6819
Practice Address - Street 1:622 DEL SOL DR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-8548
Practice Address - Country:US
Practice Address - Phone:197-587-6800
Practice Address - Fax:719-587-6819
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-990184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily