Provider Demographics
NPI:1821400995
Name:WEIR-EDMONDSON, JODI ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JODI ANN
Middle Name:
Last Name:WEIR-EDMONDSON
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 1:14568 176TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5230
Mailing Address - Country:US
Mailing Address - Phone:646-266-9530
Mailing Address - Fax:
Practice Address - Street 1:14568 176TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5230
Practice Address - Country:US
Practice Address - Phone:646-266-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313525-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse