Provider Demographics
NPI:1750048096
Name:EDWARDS, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:EDWARDS
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 1:3000 KILPATRICK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5169
Mailing Address - Country:US
Mailing Address - Phone:318-381-8584
Mailing Address - Fax:877-819-9001
Practice Address - Street 1:3000 KILPATRICK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5169
Practice Address - Country:US
Practice Address - Phone:318-381-8584
Practice Address - Fax:877-819-9001
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator