Individual
ANDREA BETH EDGERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6701 PAW PAW AVE, COLOMA, MI 49038-9519
(269) 463-3600
Mailing address
6701 PAW PAW AVE, COLOMA, MI 49038-9519
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704279479
MI
363LF0000X
Family Nurse Practitioner
28240769A
IN
363LF0000X
Family Nurse Practitioner
71007815A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178420026
MEDICARE PTAN
IN
05
—
300011718
—
IN
Enumeration date
01/24/2018
Last updated
09/08/2023
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