Provider Demographics
NPI:1033629555
Name:EDMONDSON, AMARA J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMARA
Middle Name:J
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 GIBBS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2228
Mailing Address - Country:US
Mailing Address - Phone:330-313-4996
Mailing Address - Fax:330-956-5696
Practice Address - Street 1:1937 GIBBS AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2228
Practice Address - Country:US
Practice Address - Phone:330-313-4996
Practice Address - Fax:330-956-5696
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.164005.MEDS-IV.164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse