Provider Demographics
NPI:1063129583
Name:EDWARDS, NICOLE MAY (LNA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MAY
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 VT ROUTE 140 E
Mailing Address - Street 2:
Mailing Address - City:EAST WALLINGFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05742-9542
Mailing Address - Country:US
Mailing Address - Phone:802-342-1062
Mailing Address - Fax:802-419-9351
Practice Address - Street 1:257 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4905
Practice Address - Country:US
Practice Address - Phone:802-342-1062
Practice Address - Fax:802-419-9351
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
VT075.0081403376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide