Provider Demographics
NPI:1568823805
Name:EDGIN, RACHAEL JUDITH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:JUDITH
Last Name:EDGIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 S. GREENE STREET
Mailing Address - Street 2:U. OF MARYLAND SHOCK TRAUMA, ROOM T3N30
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-3656
Mailing Address - Fax:410-328-6826
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:ROOM T3N30
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3656
Practice Address - Fax:410-328-6826
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207241363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care