Provider Demographics
NPI:1952023798
Name:EDWARDS, ANGELA MARIE (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6308
Mailing Address - Country:US
Mailing Address - Phone:937-248-4047
Mailing Address - Fax:800-883-4139
Practice Address - Street 1:715 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6308
Practice Address - Country:US
Practice Address - Phone:937-210-9507
Practice Address - Fax:800-883-4139
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000307808385H00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care