Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 13123 | HI |
N | 2086S0120X | Pediatric Surgery | 155779 | MA |
NPI | 1306810387 |
---|---|
Provider Name | Dr. Mary J Edwards |
First Address | Tripler Amc, HI 96859-5001 |
Second Address | Tripler Amc, HI 96859-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |