Provider Demographics
NPI:1063868453
Name:JOSEPH, EDWENS R (LPN)
Entity type:Individual
Prefix:
First Name:EDWENS
Middle Name:R
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NEWCOMB ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4507
Mailing Address - Country:US
Mailing Address - Phone:857-526-2849
Mailing Address - Fax:
Practice Address - Street 1:43 NEWCOMB ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4507
Practice Address - Country:US
Practice Address - Phone:857-526-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN88985164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse