Provider Demographics
NPI:1134456676
Name:EDWARDS, JESSICA ERIN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46982-0054
Mailing Address - Country:US
Mailing Address - Phone:574-268-7382
Mailing Address - Fax:
Practice Address - Street 1:205 N POPLAR
Practice Address - Street 2:
Practice Address - City:SILVERLAKE
Practice Address - State:IN
Practice Address - Zip Code:46982-0254
Practice Address - Country:US
Practice Address - Phone:574-268-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0704661376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide