Individual
CLYDE ROBERT EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Mailing address
145 KIMEL PARK DR STE 120, WINSTON SALEM, NC 27103-6983
(336) 768-3212
(336) 768-9019
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
074662
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8049968
—
NC
01
—
P00193645
RR MEDICARE
—
Enumeration date
08/31/2006
Last updated
03/18/2019
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