Provider Demographics
NPI:1003001835
Name:ANDERSON, EDITH LEWIS (R N, B S N)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:LEWIS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:R N, B S N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-3002
Mailing Address - Country:US
Mailing Address - Phone:504-393-5624
Mailing Address - Fax:504-393-5633
Practice Address - Street 1:3708 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-3002
Practice Address - Country:US
Practice Address - Phone:504-393-5624
Practice Address - Fax:504-393-5633
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA094894163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse