Provider Demographics
NPI:1760243455
Name:EDWARDS, MADELINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S KINGS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2661
Mailing Address - Country:US
Mailing Address - Phone:980-375-0550
Mailing Address - Fax:
Practice Address - Street 1:205 S KINGS DR STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2661
Practice Address - Country:US
Practice Address - Phone:980-375-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09231229363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care