Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CERTIFICATE | NC |
Y | 213ER0200X | Radiology | CERTIFICATE | NC |
NPI | 1598945826 |
---|---|
Provider Name | Ms. Susan M. Edwards |
First Address | Fayetteville, NC 28314-0954 |
Second Address | Fort Bragg, NC 28310-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2007 |
Last Update Date | 03/11/2007 |