MEDICARE: LEDA W.Z. EDWARDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA964	NV

General Provider Information

NPI Number	:	1760557151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEDA W.Z. EDWARDS PA

Provider Business Mailing Address
First Line	:	5105 E SAHARA AVE STE 134
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2989
Country	:	US
Telephone Number	:	702-375-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 E SAHARA AVE STE 134
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2989
Country	:	US
Telephone Number	:	702-534-0081
Fax Number	:	702-534-0685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	09/22/2024

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