Provider Demographics
NPI:1316968852
Name:SWEETEN, EDWARD DREW JR (RN,RT,NHA,MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DREW
Last Name:SWEETEN
Suffix:JR
Gender:M
Credentials:RN,RT,NHA,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2413
Mailing Address - Country:US
Mailing Address - Phone:702-630-5470
Mailing Address - Fax:702-870-5623
Practice Address - Street 1:6521 ELTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-2413
Practice Address - Country:US
Practice Address - Phone:702-630-5470
Practice Address - Fax:702-870-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16526163W00000X
AZRN-064931163W00000X
CARHF 125192471C3402X
AZCRT-32942471C3402X
NV174376G00000X
NM384376G00000X
AZ662376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered376G00000XNursing Service Related ProvidersNursing Home Administrator