Provider Demographics
NPI:1598416208
Name:EDWARDS, LECANDRA ANASHIA (RN)
Entity type:Individual
Prefix:
First Name:LECANDRA
Middle Name:ANASHIA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LECANDRA
Other - Middle Name:ANASHIA
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8650 N SAM HOUSTON PKWY E STE 190
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4380
Mailing Address - Country:US
Mailing Address - Phone:832-819-1415
Mailing Address - Fax:
Practice Address - Street 1:9701 N SAM HOUSTON PKWY E STE 140
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4693
Practice Address - Country:US
Practice Address - Phone:832-819-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC293207163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice