Provider Demographics
NPI:1558850768
Name:EDWARDS, DOSHAUN RENE (RN)
Entity Type:Individual
Prefix:
First Name:DOSHAUN
Middle Name:RENE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14057 ARCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1363
Mailing Address - Country:US
Mailing Address - Phone:313-412-3330
Mailing Address - Fax:313-557-0135
Practice Address - Street 1:16151 MEYERS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4108
Practice Address - Country:US
Practice Address - Phone:313-412-3330
Practice Address - Fax:313-557-0135
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse