Provider Demographics
NPI:1508132861
Name:EDWARDS, ROBERT LANSING (LPN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LANSING
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARBER AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2601
Mailing Address - Country:US
Mailing Address - Phone:518-307-4685
Mailing Address - Fax:
Practice Address - Street 1:4 BARBER AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2601
Practice Address - Country:US
Practice Address - Phone:518-307-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302343-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse