Provider Demographics
NPI:1992869200
Name:EDWARDS, WILLIAM F (CRNP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 CHESTNUT ST
Mailing Address - Street 2:RALSTON-PENN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2612
Mailing Address - Country:US
Mailing Address - Phone:215-662-3958
Mailing Address - Fax:
Practice Address - Street 1:3615 CHESTNUT ST
Practice Address - Street 2:RALSTON-PENN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2612
Practice Address - Country:US
Practice Address - Phone:215-662-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000975H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023225EJ5Medicare PIN
PA023225EJ5Medicare ID - Type Unspecified
S71281Medicare UPIN