Basic Information
Provider Information
NPI: 1306373477
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EDWARDS
FirstName: ERIN
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 EMBARCADERO CTR STE 1900
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941113723
CountryCode: US
TelephoneNumber: 4156586791
FaxNumber:  
Practice Location
Address1: 2 EMBARCADERO CTR
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941113823
CountryCode: US
TelephoneNumber: 8886636331
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/18/2017
LastUpdateDate: 12/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X777860CAN Nursing Service ProvidersRegistered Nurse 
363LF0000X95007244CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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