Provider Demographics
NPI:1982672655
Name:EDWARDS, ERIC E (RN MSN FNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 HIGHWAY 83 NORTH
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-1380
Mailing Address - Country:US
Mailing Address - Phone:406-677-2277
Mailing Address - Fax:406-677-2387
Practice Address - Street 1:401 RAILROAD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4109
Practice Address - Country:US
Practice Address - Phone:406-258-4789
Practice Address - Fax:406-258-4732
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000384684OtherANTHEM
IN200202960AMedicaid
MT19822672655Medicaid
IN200202960AMedicaid
INCG3197Medicare PIN
S87788Medicare UPIN
MT011003518Medicare PIN
IN500017457Medicare PIN