Provider Demographics
NPI:1285977918
Name:EDWARDS-FOWLER, BRITTANY (LPN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:EDWARDS-FOWLER
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 1:1137 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1324
Mailing Address - Country:US
Mailing Address - Phone:516-851-4374
Mailing Address - Fax:
Practice Address - Street 1:1137 SOUTH DR
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1324
Practice Address - Country:US
Practice Address - Phone:516-851-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312518-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse