Provider Demographics
NPI:1437875770
Name:EDGEHOUSE, COLLEEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:EDGEHOUSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3121
Mailing Address - Country:US
Mailing Address - Phone:216-299-1471
Mailing Address - Fax:
Practice Address - Street 1:26901 BROOKPARK ROAD EXT
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3176
Practice Address - Country:US
Practice Address - Phone:440-471-7044
Practice Address - Fax:833-741-2649
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily