Provider Demographics
NPI:1407153067
Name:EDWARDS, PATRICIA ANNE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2527
Mailing Address - Country:US
Mailing Address - Phone:631-344-3670
Mailing Address - Fax:631-344-7366
Practice Address - Street 1:30 BELL AVENUE
Practice Address - Street 2:BROOKHAVEN NATIONAL LABORATORY, OMC, BLDG. 490
Practice Address - City:UPTON
Practice Address - State:NY
Practice Address - Zip Code:11973-5000
Practice Address - Country:US
Practice Address - Phone:631-344-3670
Practice Address - Fax:631-344-7366
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303772363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health