Provider Demographics
NPI:1386392116
Name:EDWARDS, VERONICA L
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:L
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 1:5112 RIDGEDALE RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-6017
Mailing Address - Country:US
Mailing Address - Phone:251-367-4797
Mailing Address - Fax:
Practice Address - Street 1:5112 RIDGEDALE RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-6017
Practice Address - Country:US
Practice Address - Phone:251-367-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 174200000X, 372500000X, 3747P1801X, 251E00000X
AL222197246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No372500000XNursing Service Related ProvidersChore Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant