Provider Demographics
NPI:1467609693
Name:EDWARDS, LOLITA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 PROSPECT AVE
Mailing Address - Street 2:APT. 4B
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2467
Mailing Address - Country:US
Mailing Address - Phone:201-398-6375
Mailing Address - Fax:
Practice Address - Street 1:216 PROSPECT AVE
Practice Address - Street 2:APT. 4B
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2467
Practice Address - Country:US
Practice Address - Phone:201-398-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586703-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse