Provider Demographics
NPI:1306504709
Name:EDWARDS, JACQUELYN ANDREA
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANDREA
Last Name:EDWARDS
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 1:611 N ST NW UNIT Y2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3421
Mailing Address - Country:US
Mailing Address - Phone:202-300-2206
Mailing Address - Fax:
Practice Address - Street 1:238 DIVISION AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5462
Practice Address - Country:US
Practice Address - Phone:202-300-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide