Provider Demographics
NPI:1245671122
Name:EDWARDS, SHELLY ANN (ARNP)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-3866
Mailing Address - Country:US
Mailing Address - Phone:641-455-5200
Mailing Address - Fax:641-455-5150
Practice Address - Street 1:920 N QUINCY AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-3866
Practice Address - Country:US
Practice Address - Phone:641-455-5200
Practice Address - Fax:641-455-5150
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA078405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA078405OtherLICENSE #
IA1245671122OtherNPI #