Provider Demographics
NPI:1255169579
Name:TEMP, EDWARD
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TEMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23108 NIGHTINGALE ST NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-9640
Mailing Address - Country:US
Mailing Address - Phone:612-910-2857
Mailing Address - Fax:
Practice Address - Street 1:23108 NIGHTINGALE ST NW
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9640
Practice Address - Country:US
Practice Address - Phone:612-910-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNQB808212171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications