Provider Demographics
NPI:1952520090
Name:EDWARDS, GLORIA MASCARI (LPN)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MASCARI
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1402
Mailing Address - Country:US
Mailing Address - Phone:513-367-6602
Mailing Address - Fax:
Practice Address - Street 1:125 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1402
Practice Address - Country:US
Practice Address - Phone:800-616-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58801305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2288957Medicaid