Provider Demographics
NPI:1659801264
Name:VINCENT, EDITH NNEOMA (RN, NURSE)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:NNEOMA
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RN, NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11829 GWEN EVANS LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5585
Mailing Address - Country:US
Mailing Address - Phone:914-414-6124
Mailing Address - Fax:
Practice Address - Street 1:11829 GWEN EVANS LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:914-414-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY519162-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse