Provider Demographics
NPI:1639597461
Name:EDEH, CARLA (RN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:EDEH
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 1:4947 FARNHURST RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2328
Mailing Address - Country:US
Mailing Address - Phone:216-324-3325
Mailing Address - Fax:
Practice Address - Street 1:4947 FARNHURST RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2328
Practice Address - Country:US
Practice Address - Phone:216-324-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN289023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse