Healthcare Provider Details

I. General information

NPI: 1811207285
Provider Name (Legal Business Name): MRS. JOANNE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 NW RALEIGH ST 305
PORTLAND OR
97209-1753
US

IV. Provider business mailing address

3255 N WILLAMETTE BLVD
PORTLAND OR
97217-5139
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-2449
  • Fax:
Mailing address:
  • Phone: 503-919-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: