Provider Demographics
NPI:1366868325
Name:EDWARDS, RAY SR (LPN)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:EDWARDS
Suffix:SR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2527
Mailing Address - Country:US
Mailing Address - Phone:716-523-9997
Mailing Address - Fax:
Practice Address - Street 1:303 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-2527
Practice Address - Country:US
Practice Address - Phone:716-523-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265188-1372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider