Provider Demographics
NPI:1609463777
Name:LULE, EDITH (LPN)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:LULE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13828 BETHPAGE LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3103
Mailing Address - Country:US
Mailing Address - Phone:240-483-1311
Mailing Address - Fax:
Practice Address - Street 1:13828 BETHPAGE LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3103
Practice Address - Country:US
Practice Address - Phone:240-483-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP39839164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse