Provider Demographics
NPI:1841069358
Name:AVALOS, EDNAL HUMBERTO (LPN)
Entity type:Individual
Prefix:
First Name:EDNAL
Middle Name:HUMBERTO
Last Name:AVALOS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 NEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3346
Mailing Address - Country:US
Mailing Address - Phone:732-277-1907
Mailing Address - Fax:
Practice Address - Street 1:360 NEVILLE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3346
Practice Address - Country:US
Practice Address - Phone:732-277-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP49525700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse