Provider Demographics
NPI:1811573884
Name:LEE-EDWARDS, CELISSA FLORENCE (LPN)
Entity Type:Individual
Prefix:
First Name:CELISSA
Middle Name:FLORENCE
Last Name:LEE-EDWARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 AHERN DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3400
Mailing Address - Country:US
Mailing Address - Phone:720-941-0346
Mailing Address - Fax:
Practice Address - Street 1:336 AHERN DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3400
Practice Address - Country:US
Practice Address - Phone:720-941-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP-50346164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse