Provider Demographics
NPI:1992458434
Name:EDWARDS, VONETTA (RDMS)
Entity type:Individual
Prefix:
First Name:VONETTA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 WOOD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2106
Mailing Address - Country:US
Mailing Address - Phone:301-455-0849
Mailing Address - Fax:
Practice Address - Street 1:6312 WOOD POINTE DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2106
Practice Address - Country:US
Practice Address - Phone:301-455-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1356982471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography