Provider Demographics
NPI:1679701114
Name:EDWARDS, PATRICIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:NYAHWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:795 BRIDGE ST
Mailing Address - Street 2:APT 1
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1604
Mailing Address - Country:US
Mailing Address - Phone:978-996-5234
Mailing Address - Fax:
Practice Address - Street 1:795 BRIDGE ST
Practice Address - Street 2:APT 1
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1604
Practice Address - Country:US
Practice Address - Phone:978-996-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239235163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081311AOtherMASSHEALTH PROVIDER ID/SERVICE LOCATION