Provider Demographics
NPI:1598065443
Name:EDWARDS, ALLISON DELORES (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:DELORES
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:DELORES
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1359 BALCOM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5801
Mailing Address - Country:US
Mailing Address - Phone:718-710-3196
Mailing Address - Fax:
Practice Address - Street 1:1359 BALCOM AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5801
Practice Address - Country:US
Practice Address - Phone:718-710-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292210-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse