Provider Demographics
NPI:1841895570
Name:EDWARDS, THERESA LOUISE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
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 1:5023 PICKFAIR DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2940
Mailing Address - Country:US
Mailing Address - Phone:419-787-8741
Mailing Address - Fax:
Practice Address - Street 1:5023 PICKFAIR DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2940
Practice Address - Country:US
Practice Address - Phone:419-787-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492600Medicaid