Provider Demographics
NPI:1881459311
Name:EDWARDS, LOLA JANE (RN)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:JANE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 S HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3576
Mailing Address - Country:US
Mailing Address - Phone:918-360-7014
Mailing Address - Fax:866-310-4081
Practice Address - Street 1:5705 E 71ST ST STE 250
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6680
Practice Address - Country:US
Practice Address - Phone:918-477-9080
Practice Address - Fax:918-948-7735
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0044395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0044395OtherRN LICENSE