Healthcare Provider Details

I. General information

NPI: 1821913088
Provider Name (Legal Business Name): EFFIE ELIZABETH EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2508
US

IV. Provider business mailing address

2010 HUNTINGTON DR
SOUTH PASADENA CA
91030-4924
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-2362
  • Fax:
Mailing address:
  • Phone: 479-200-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: