Provider Demographics
NPI:1114228343
Name:EDME, ELSIE T
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:T
Last Name:EDME
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 1:2229 EDGEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:FAROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-868-4494
Mailing Address - Fax:
Practice Address - Street 1:2229 EDGEMERE AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2715
Practice Address - Country:US
Practice Address - Phone:718-868-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2993431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse