Provider Demographics
NPI:1215281449
Name:EDWARDS, REBECCA ELLEN (LMP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ELLEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 200TH ST SW
Mailing Address - Street 2:APT #202
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6366
Mailing Address - Country:US
Mailing Address - Phone:425-780-3532
Mailing Address - Fax:
Practice Address - Street 1:4813 200TH ST SW
Practice Address - Street 2:APT #202
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6366
Practice Address - Country:US
Practice Address - Phone:425-780-3532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303669172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker