Provider Demographics
NPI:1598480394
Name:EDGE, TARYNE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TARYNE
Middle Name:MARIE
Last Name:EDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARYNE
Other - Middle Name:MARIE
Other - Last Name:PAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4309 WESTLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-6111
Mailing Address - Country:US
Mailing Address - Phone:734-788-7928
Mailing Address - Fax:
Practice Address - Street 1:5570 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9752
Practice Address - Country:US
Practice Address - Phone:734-780-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704364093163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice