Provider Demographics
NPI:1013229764
Name:EDEL, JOYCE LINDA (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:LINDA
Last Name:EDEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DARK HOLLOW RD
Mailing Address - Street 2:APT 4A
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2049
Mailing Address - Country:US
Mailing Address - Phone:631-828-5399
Mailing Address - Fax:
Practice Address - Street 1:1 DARK HOLLOW RD
Practice Address - Street 2:APT 4A
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2049
Practice Address - Country:US
Practice Address - Phone:631-828-5399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY367003-1163W00000X
SC101865163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse