Provider Demographics
NPI:1376282749
Name:EDOL, LODIE ALVERSEAU
Entity Type:Individual
Prefix:
First Name:LODIE
Middle Name:ALVERSEAU
Last Name:EDOL
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 1:6339 REDWOOD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-2738
Mailing Address - Country:US
Mailing Address - Phone:860-772-5474
Mailing Address - Fax:
Practice Address - Street 1:6339 REDWOOD OAKS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-2738
Practice Address - Country:US
Practice Address - Phone:860-772-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health