Provider Demographics
NPI:1508439175
Name:EDWARDS, WILLIE DEAN
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:DEAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 HANSBROUGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1717
Mailing Address - Country:US
Mailing Address - Phone:504-875-4151
Mailing Address - Fax:
Practice Address - Street 1:7351 HANSBROUGH ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1717
Practice Address - Country:US
Practice Address - Phone:504-875-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA005652112343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)