Provider Demographics
NPI:1215330121
Name:EDWARDS, REBECCA LYNNE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
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 1:20 MEDICINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-660-2160
Mailing Address - Fax:919-668-7345
Practice Address - Street 1:20 MEDICINE CIRCLE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-660-2160
Practice Address - Fax:919-668-7345
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007512363L00000X, 363LA2200X
NC241809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3217Medicaid
NC1215330121Medicaid
NCNCN651BMedicare PIN
NCNCN651AMedicare PIN