| Doctor Name: | MRS. MIRA EDGERTON |
| NPI Number: | 1033352265 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 4704092938 |
| Business Practice Address: | 4397 Stoneycroft Dr Okemos, MI - 488642935 |
| Business Phone Number: | 5173490737 |
| Business Fax Number: | |
| Mailing Address: | 4397 Stoneycroft Dr, OKEMOS |
| State: | MI |
| Postal Code: | 488642935 |
| Phone Number: | 5173490737 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2009 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | 4704092938 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |