Provider Demographics
NPI:1134169428
Name:EDWARDS, FLOYD DALE (LPN)
Entity type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:DALE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 BREAKING DAWN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-1123
Mailing Address - Country:US
Mailing Address - Phone:719-391-5116
Mailing Address - Fax:719-391-5117
Practice Address - Street 1:1650 COCHRANE CIRRCLE
Practice Address - Street 2:USA MEDDAC / EVANS ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7649
Practice Address - Fax:719-526-7019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27927164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse