Provider Demographics
NPI:1093578627
Name:EDWARDS, QUEENIE
Entity Type:Individual
Prefix:
First Name:QUEENIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14509 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1074
Mailing Address - Country:US
Mailing Address - Phone:216-334-4229
Mailing Address - Fax:
Practice Address - Street 1:14509 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1074
Practice Address - Country:US
Practice Address - Phone:216-334-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver