Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME108877 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME108877 | FL |
Y | 2080P0210X | Pediatric Nephrologist | MD61102201 | WA |
N | 2080P0210X | Pediatric Nephrologist | ME108877 | FL |
NPI | 1689815573 |
---|---|
Provider Name | Alcia Delaney Edwards-Richards |
First Address | Liberty Lake, WA 99019-0421 |
Second Address | Spokane, WA 99204-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012075000 | (05) | FL |