Provider Demographics
NPI:1326525528
Name:EDWARDS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EDWARDS
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 1:24020 W RIVERWALK CT STE 122
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7126
Mailing Address - Country:US
Mailing Address - Phone:815-770-7060
Mailing Address - Fax:
Practice Address - Street 1:24020 W RIVERWALK CT STE 122
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7126
Practice Address - Country:US
Practice Address - Phone:815-770-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion