Provider Demographics
NPI:1184001539
Name:WILLIAM, EDNA
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:WILLIAM
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 1:44 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-6110
Mailing Address - Country:US
Mailing Address - Phone:240-467-4897
Mailing Address - Fax:
Practice Address - Street 1:44 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6110
Practice Address - Country:US
Practice Address - Phone:240-467-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2337512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse