Healthcare Provider Details

I. General information

NPI: 1174726673
Provider Name (Legal Business Name): VANESSA EDWARDS NMD, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 SALEM AVE
DAYTON OH
45416-1707
US

IV. Provider business mailing address

4380 SALEM AVE
DAYTON OH
45416-1707
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-9473
  • Fax: 937-274-5799
Mailing address:
  • Phone: 937-275-9473
  • Fax: 937-274-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number05858
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000194
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: