MEDICARE: MRS. AMARA J EDMONDSON LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN.164005.MEDS-IV.	OH

General Provider Information

NPI Number	:	1033629555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMARA J EDMONDSON LPN

Provider Business Mailing Address
First Line	:	1937 GIBBS AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2228
Country	:	US
Telephone Number	:	330-313-4996
Fax Number	:	330-956-5696

Provider Business Practice Location Address
First Line	:	1937 GIBBS AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2228
Country	:	US
Telephone Number	:	330-313-4996
Fax Number	:	330-956-5696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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