Provider Demographics
NPI:1841582798
Name:EDWARDS, CARRIE DENISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:DENISE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 W RUSSWORM DR
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-4840
Mailing Address - Country:US
Mailing Address - Phone:405-262-2294
Mailing Address - Fax:405-262-4788
Practice Address - Street 1:500 N ADMIRE AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-1802
Practice Address - Country:US
Practice Address - Phone:405-262-2294
Practice Address - Fax:405-262-4788
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN0309577163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse