Provider Demographics
NPI:1427323989
Name:EDWARDS, JOLENE B (RN)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:B
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 W WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1950
Mailing Address - Country:US
Mailing Address - Phone:623-451-5564
Mailing Address - Fax:623-486-4481
Practice Address - Street 1:215 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2321
Practice Address - Country:US
Practice Address - Phone:480-270-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ126132163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant