Provider Demographics
NPI:1558332346
Name:EDWARDS, LORRAINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W 2ND ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4684
Mailing Address - Country:US
Mailing Address - Phone:402-463-1250
Mailing Address - Fax:402-463-1461
Practice Address - Street 1:2727 W 2ND ST
Practice Address - Street 2:SUITE 340
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4684
Practice Address - Country:US
Practice Address - Phone:402-463-1250
Practice Address - Fax:402-463-1461
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE200772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250159/00Medicaid
NE130014288OtherRR MEDICARE
G31686Medicare UPIN