Provider Demographics
NPI:1740627983
Name:EDWARDS, JUDY WADDELL (RN)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:WADDELL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 CAVALIER WAY
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3367
Mailing Address - Country:US
Mailing Address - Phone:864-576-4212
Mailing Address - Fax:864-595-2411
Practice Address - Street 1:1390 CAVALIER WAY
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3367
Practice Address - Country:US
Practice Address - Phone:864-576-4212
Practice Address - Fax:864-595-2411
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse