Provider Demographics
NPI:1760557151
Name:EDWARDS, LEDA WZ (PAC)
Entity Type:Individual
Prefix:
First Name:LEDA
Middle Name:WZ
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MOUNTAIN VISTA
Mailing Address - Street 2:SUITE #205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-614-5437
Mailing Address - Fax:702-990-9922
Practice Address - Street 1:6301 MOUNTAIN VISTA
Practice Address - Street 2:SUITE #205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-614-5437
Practice Address - Fax:702-990-9922
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA964363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical