Provider Demographics
NPI:1154502904
Name:EDWARDS, THARSILLA ULIN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:THARSILLA
Middle Name:ULIN
Last Name: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 1:66 BROADWAY
Mailing Address - Street 2:APT#2
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7138
Mailing Address - Country:US
Mailing Address - Phone:617-595-8397
Mailing Address - Fax:617-773-2835
Practice Address - Street 1:66 BROADWAY
Practice Address - Street 2:APT#2
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7138
Practice Address - Country:US
Practice Address - Phone:617-595-8397
Practice Address - Fax:617-773-2835
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA67184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse