Individual
BROOKE OSBORNE EDMISTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1126 N CHURCH ST, SUITE 300, GREENSBORO, NC 27401-1000
(336) 547-1752
(336) 547-1858
Mailing address
1126 N CHURCH ST, SUITE 300, GREENSBORO, NC 27401-1000
(336) 547-1752
(336) 547-1858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00129
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8101245
—
NC
Enumeration date
01/20/2006
Last updated
10/16/2019
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