Provider Demographics
NPI:1326867003
Name:EDWARDS, CRISTI DE'SHAE
Entity type:Individual
Prefix:
First Name:CRISTI
Middle Name:DE'SHAE
Last Name:EDWARDS
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 1:4574 BRIMMER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7797
Mailing Address - Country:US
Mailing Address - Phone:336-413-9619
Mailing Address - Fax:
Practice Address - Street 1:4574 BRIMMER PLACE DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7797
Practice Address - Country:US
Practice Address - Phone:336-413-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1401108358163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty