Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 37913 | WV |
NPI | 1285910687 |
---|---|
Provider Name | Mrs. Ada Jacqueline Edwards |
First Address | Huntington, WV 25701-3800 |
Second Address | Huntington, WV 25701-3800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2011 |
Last Update Date | 30/10/2011 |