Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN.CNP.022941 | OH |
NPI | 1013494558 |
---|---|
Provider Name | Mrs. Theresa Kay Edwards |
First Address | Sidney, OH 45365-8144 |
Second Address | Sidney, OH 45365-8144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 01/12/2020 |