Provider Demographics
NPI:1508510132
Name:EDE, LARRY EDWARD (NP)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:EDWARD
Last Name:EDE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2400
Mailing Address - Country:US
Mailing Address - Phone:440-669-5670
Mailing Address - Fax:440-428-4104
Practice Address - Street 1:5824 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2400
Practice Address - Country:US
Practice Address - Phone:440-669-5670
Practice Address - Fax:440-428-4104
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030430363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health