Provider Demographics
NPI:1902107667
Name:EDWARDS, TAMMEY LORRAINE (RN)
Entity Type:Individual
Prefix:MS
First Name:TAMMEY
Middle Name:LORRAINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 LA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH FALLSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12779-5206
Mailing Address - Country:US
Mailing Address - Phone:845-901-9546
Mailing Address - Fax:
Practice Address - Street 1:248 LA VISTA DR
Practice Address - Street 2:
Practice Address - City:SOUTH FALLSBURG
Practice Address - State:NY
Practice Address - Zip Code:12779-5206
Practice Address - Country:US
Practice Address - Phone:845-901-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY536737-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health