Provider Demographics
NPI:1215640867
Name:CHILDS, EDWINA (LPN)
Entity type:Individual
Prefix:
First Name:EDWINA
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2634
Mailing Address - Country:US
Mailing Address - Phone:616-570-6727
Mailing Address - Fax:
Practice Address - Street 1:1400 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2634
Practice Address - Country:US
Practice Address - Phone:616-570-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X
MI4703114103164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care