Provider Demographics
NPI:1770896516
Name:EDMONDS, NIKKI NICOLE
Entity type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:NICOLE
Last Name:EDMONDS
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 1:4040 PALOS VERDES CT
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3865
Mailing Address - Country:US
Mailing Address - Phone:937-251-4667
Mailing Address - Fax:
Practice Address - Street 1:4040 PALOS VERDES CT
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-3865
Practice Address - Country:US
Practice Address - Phone:937-251-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse