Provider Demographics
NPI:1437868627
Name:EDWARDS, TANESE S (NP)
Entity Type:Individual
Prefix:MS
First Name:TANESE
Middle Name:S
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W MARTIN LUTHER KING JR BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2660
Mailing Address - Country:US
Mailing Address - Phone:323-898-2773
Mailing Address - Fax:
Practice Address - Street 1:3010 W MARTIN LUTHER KING JR BLVD APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-2660
Practice Address - Country:US
Practice Address - Phone:323-898-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily