Provider Demographics
NPI:1225890130
Name:EDWARDS, DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
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 1:5595 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3301
Mailing Address - Country:US
Mailing Address - Phone:216-450-7144
Mailing Address - Fax:
Practice Address - Street 1:5595 GARDEN ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3301
Practice Address - Country:US
Practice Address - Phone:216-450-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187687164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse