Provider Demographics
NPI:1427608793
Name:EDWARDS, THERESA T
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:T
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:T
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 OLD CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2039
Mailing Address - Country:US
Mailing Address - Phone:407-580-9466
Mailing Address - Fax:215-242-2456
Practice Address - Street 1:44 OLD CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2039
Practice Address - Country:US
Practice Address - Phone:407-580-9466
Practice Address - Fax:215-242-2456
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA43373601376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker