MEDICARE: MS. DEANGELA EDWARDS LPN

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	164W00000X	Licensed Practical Nurse	2001006601	MO

General Provider Information

NPI Number	:	1801291398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANGELA EDWARDS LPN

Provider Business Mailing Address
First Line	:	2638 SAN RAFAEL PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5135
Country	:	US
Telephone Number	:	314-265-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2638 SAN RAFAEL PL
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-5135
Country	:	US
Telephone Number	:	314-265-1221
Fax Number	:

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	10/27/2014

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