Provider Demographics
NPI:1679717078
Name:EDWARDS, DONNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 CARMAN ST
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-9711
Mailing Address - Country:US
Mailing Address - Phone:952-471-8155
Mailing Address - Fax:
Practice Address - Street 1:2474 CARMAN ST
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-9711
Practice Address - Country:US
Practice Address - Phone:952-471-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12037208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics