Provider Demographics
NPI:1174726673
Name:EDWARDS, VANESSA (NMD, LAC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1707
Mailing Address - Country:US
Mailing Address - Phone:937-275-9473
Mailing Address - Fax:937-274-5799
Practice Address - Street 1:4380 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1707
Practice Address - Country:US
Practice Address - Phone:937-275-9473
Practice Address - Fax:937-274-5799
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05858175F00000X
OH000194171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath