Provider Demographics
NPI:1023351491
Name:EDWARDS, ANDREA NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
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 1:895 THE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2044
Mailing Address - Country:US
Mailing Address - Phone:716-297-2981
Mailing Address - Fax:
Practice Address - Street 1:895 THE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2044
Practice Address - Country:US
Practice Address - Phone:716-297-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309235164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse