Provider Demographics
NPI:1689269342
Name:EDWARDS, SHERITA NICOLE (CNA)
Entity Type:Individual
Prefix:MISS
First Name:SHERITA
Middle Name:NICOLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14736 DOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2313
Mailing Address - Country:US
Mailing Address - Phone:708-224-6471
Mailing Address - Fax:708-487-9293
Practice Address - Street 1:14736 DOBSON AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-2313
Practice Address - Country:US
Practice Address - Phone:708-224-6471
Practice Address - Fax:708-487-9293
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp