Provider Demographics
NPI:1174004915
Name:CANTU, EDNA MARIE I (LVN)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:MARIE
Last Name:CANTU
Suffix:I
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 CASTLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1469
Mailing Address - Country:US
Mailing Address - Phone:512-971-3420
Mailing Address - Fax:
Practice Address - Street 1:1611 CASTLEWOOD CT
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1469
Practice Address - Country:US
Practice Address - Phone:512-971-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69108164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse