Provider Demographics
NPI:1063842250
Name:EDMUNDS, JANICE
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 CARL BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:ME
Mailing Address - Zip Code:04539-3251
Mailing Address - Country:US
Mailing Address - Phone:207-563-3511
Mailing Address - Fax:207-563-3561
Practice Address - Street 1:199 CARL BAILEY RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:ME
Practice Address - Zip Code:04539-3251
Practice Address - Country:US
Practice Address - Phone:207-563-3511
Practice Address - Fax:207-563-3561
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME$$$$$$$$$OtherSOCIAL SECURITY #