Provider Demographics
NPI:1932401882
Name:EDWARDS, LAURA WRENN (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:WRENN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0654
Mailing Address - Country:US
Mailing Address - Phone:434-447-9033
Mailing Address - Fax:434-447-9034
Practice Address - Street 1:501 LOMBARDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2107
Practice Address - Country:US
Practice Address - Phone:434-447-9033
Practice Address - Fax:434-447-9034
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169080363LF0000X
NC5004980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2274683OtherDEA