Provider Demographics
NPI:1134008881
Name:EDGELL, STEVEN ROBERT JR
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:EDGELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 MEADOW LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9612
Mailing Address - Country:US
Mailing Address - Phone:559-760-5320
Mailing Address - Fax:
Practice Address - Street 1:49370 ROAD 426 STE B
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9052
Practice Address - Country:US
Practice Address - Phone:553-641-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95410827163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency