Individual
GINA LYNN EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 HUNDERTMARK RD, CHASKA, MN 55318-4551
(952) 556-0071
Mailing address
560 SOUTH MAPLE ST, SUITE 130, WACONIA, MN 55387
(952) 856-4003
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
128639
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41177800
—
WI
Enumeration date
09/21/2006
Last updated
10/24/2017
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