Provider Demographics
NPI:1790525004
Name:EDWARDS, DAJANAE
Entity type:Individual
Prefix:
First Name:DAJANAE
Middle Name:
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 1:19963 WESTPHALIA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1748
Mailing Address - Country:US
Mailing Address - Phone:313-979-0582
Mailing Address - Fax:
Practice Address - Street 1:19963 WESTPHALIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1748
Practice Address - Country:US
Practice Address - Phone:313-979-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide