Provider Demographics
NPI:1386480549
Name:EDWARDSON, RAE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:RAE
Middle Name:ANN
Last Name:EDWARDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:AR
Mailing Address - Zip Code:72569-9121
Mailing Address - Country:US
Mailing Address - Phone:870-283-2077
Mailing Address - Fax:
Practice Address - Street 1:4 S FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:AR
Practice Address - Zip Code:72569-9121
Practice Address - Country:US
Practice Address - Phone:870-283-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR87997163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy