Provider Demographics
NPI:1982452421
Name:EDWARDS, DANIELLE LAURIE (LMP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LAURIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 IRELAND RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-4570
Mailing Address - Country:US
Mailing Address - Phone:541-852-7143
Mailing Address - Fax:
Practice Address - Street 1:1980 LANDERS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-4705
Practice Address - Country:US
Practice Address - Phone:541-852-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist