Healthcare Provider Details

I. General information

NPI: 1689269342
Provider Name (Legal Business Name): SHERITA NICOLE EDWARDS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14736 DOBSON AVE
DOLTON IL
60419-2313
US

IV. Provider business mailing address

14736 DOBSON AVE
DOLTON IL
60419-2313
US

V. Phone/Fax

Practice location:
  • Phone: 708-224-6471
  • Fax: 708-487-9293
Mailing address:
  • Phone: 708-224-6471
  • Fax: 708-487-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: