Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 23593 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN265652 | GA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 5012813 | NC |
NPI | 1053943647 |
---|---|
Provider Name | Amaya Edge |
First Address | Aiken, SC 29803-6183 |
Second Address | Evans, GA 30809-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 05/08/2021 |