Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 15935 | CA |
NPI | 1003945817 |
---|---|
Provider Name | Mrs. Anna Lynn Edwards |
First Address | Glendora, CA 91741-2034 |
Second Address | Glendora, CA 91741-2034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |