Provider Demographics
NPI:1629856844
Name:EDWARDS, TREMAYNE (TRANSPORTATION)
Entity Type:Individual
Prefix:
First Name:TREMAYNE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:TREMAYNE
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROVIDER
Mailing Address - Street 1:3414 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3329
Mailing Address - Country:US
Mailing Address - Phone:662-655-9777
Mailing Address - Fax:
Practice Address - Street 1:4375 N 53RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1356
Practice Address - Country:US
Practice Address - Phone:662-655-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIE3638048144805343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)