Healthcare Provider Details

I. General information

NPI: 1902722846
Provider Name (Legal Business Name): STEPHANIE F EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25690 NUWAY AVE
WARREN MI
48091-6036
US

IV. Provider business mailing address

25690 NUWAY AVE
WARREN MI
48091-6036
US

V. Phone/Fax

Practice location:
  • Phone: 231-559-9080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: