Provider Demographics
NPI:1922857085
Name:EDWARDS, OLIVIA M
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-3004
Mailing Address - Country:US
Mailing Address - Phone:318-751-5917
Mailing Address - Fax:
Practice Address - Street 1:806 W GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-3004
Practice Address - Country:US
Practice Address - Phone:318-751-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator