Provider Demographics
NPI:1467887471
Name:EDWARDS, KETURA'H RENEE (RN/NP)
Entity Type:Individual
Prefix:
First Name:KETURA'H
Middle Name:RENEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN/NP
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 DIMOCK ST
Mailing Address - Street 2:DEPT 772
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1029
Mailing Address - Country:US
Mailing Address - Phone:617-442-8800
Mailing Address - Fax:
Practice Address - Street 1:45 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1208
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2281272363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health