Provider Demographics
NPI:1811207285
Name:EDWARDS, JOANNE
Entity type:Individual
Prefix:MRS
First Name:JOANNE
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 1:3255 N WILLAMETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5139
Mailing Address - Country:US
Mailing Address - Phone:503-919-8901
Mailing Address - Fax:
Practice Address - Street 1:1722 NW RALEIGH ST
Practice Address - Street 2:305
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1753
Practice Address - Country:US
Practice Address - Phone:503-567-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN