Provider Demographics
NPI:1265252118
Name:EDGAR, STEFANIE (BSN, RN, CWON)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:EDGAR
Suffix:
Gender:F
Credentials:BSN, RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1129
Mailing Address - Country:US
Mailing Address - Phone:703-863-4436
Mailing Address - Fax:
Practice Address - Street 1:3181 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1129
Practice Address - Country:US
Practice Address - Phone:757-496-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001296945163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005469144OtherWOCNCB