Provider Demographics
NPI:1730391954
Name:JEANNE M EDWARDS PC
Entity type:Organization
Organization Name:JEANNE M EDWARDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNSTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CPC
Authorized Official - Phone:9187-121-7900
Mailing Address - Street 1:1717-B S UTICA SUITE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-712-7900
Mailing Address - Fax:918-712-9757
Practice Address - Street 1:1717-B S UTICA SUITE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-712-7900
Practice Address - Fax:918-712-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty