Organization
EDGE INTEGRATIVE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK HEAD (BILLER)
(520) 730-2534
Entity
Organization
Contact information
Practice address
2450 N WILLOW RANCH RD, TUCSON, AZ 85749-6705
(520) 730-2534
Mailing address
2450 N WILLOW RANCH RD, TUCSON, AZ 85749-6705
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11937739
CAQH
—
Enumeration date
01/10/2018
Last updated
01/10/2018
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