Provider Demographics
NPI:1952602880
Name:WARE, EDITH JOAN
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:JOAN
Last Name:WARE
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 1:807 CHASTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7080
Mailing Address - Country:US
Mailing Address - Phone:704-701-7392
Mailing Address - Fax:
Practice Address - Street 1:807 CHASTAIN AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7080
Practice Address - Country:US
Practice Address - Phone:704-701-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)