Provider Demographics
NPI:1093471781
Name:HURT-EDWARDS, GWENDOLYN FAYE (LPN)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:FAYE
Last Name:HURT-EDWARDS
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 1:3000 GETWELL RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2205
Mailing Address - Country:US
Mailing Address - Phone:901-422-6000
Mailing Address - Fax:901-542-0167
Practice Address - Street 1:3900 NEW COVINGTON PIKE STE 112
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2526
Practice Address - Country:US
Practice Address - Phone:662-655-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS329824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse