Provider Demographics
NPI:1639940075
Name:EDLOW, KEYAIRRA
Entity Type:Individual
Prefix:
First Name:KEYAIRRA
Middle Name:
Last Name:EDLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 LEIDY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1014
Mailing Address - Country:US
Mailing Address - Phone:267-581-8300
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7157
Practice Address - Country:US
Practice Address - Phone:215-694-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician