Provider Demographics
NPI:1265235394
Name:EDWARDS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 S LEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68871-9752
Mailing Address - Country:US
Mailing Address - Phone:308-930-0913
Mailing Address - Fax:
Practice Address - Street 1:139 S LEY ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:NE
Practice Address - Zip Code:68871-9752
Practice Address - Country:US
Practice Address - Phone:308-930-0913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion