Provider Demographics
NPI:1720762925
Name:EDGE, MAE
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:EDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COURTHOUSE TER
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3511
Mailing Address - Country:US
Mailing Address - Phone:850-849-8560
Mailing Address - Fax:
Practice Address - Street 1:121 COURTHOUSE TER
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3511
Practice Address - Country:US
Practice Address - Phone:850-849-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula