Provider Demographics
NPI:1982672655
Name:EDWARDS, ERIC E (RN MSN FNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:E
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RN MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-768-5858
Mailing Address - Fax:319-752-4653
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3452
Practice Address - Country:US
Practice Address - Phone:319-524-5734
Practice Address - Fax:319-524-5758
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38495363L00000X
IAA136409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200202960AMedicaid
IN000000384684OtherANTHEM
MT19822672655Medicaid
IN200202960AMedicaid
INCG3197Medicare PIN
S87788Medicare UPIN
MT011003518Medicare PIN
IN500017457Medicare PIN