Provider Demographics
NPI:1225206832
Name:EDWARDS, CARRIE (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SAW MILL LN
Mailing Address - Street 2:
Mailing Address - City:SHICKSHINNY
Mailing Address - State:PA
Mailing Address - Zip Code:18655-4626
Mailing Address - Country:US
Mailing Address - Phone:570-542-7253
Mailing Address - Fax:
Practice Address - Street 1:43 SAW MILL LN
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655-4626
Practice Address - Country:US
Practice Address - Phone:570-542-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003088133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA086928Medicare PIN