Provider Demographics
NPI:1891248761
Name:EDWARDS, DENA LOUISE
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:LOUISE
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 1:107 S UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3213
Mailing Address - Country:US
Mailing Address - Phone:605-868-9376
Mailing Address - Fax:
Practice Address - Street 1:107 S UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3213
Practice Address - Country:US
Practice Address - Phone:605-868-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver