Provider Demographics
NPI:1356753941
Name:EDOUARD, NANCIE
Entity type:Individual
Prefix:MRS
First Name:NANCIE
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCIE
Other - Middle Name:
Other - Last Name:EDOUARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:846 BAUER ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4317
Mailing Address - Country:US
Mailing Address - Phone:516-360-6995
Mailing Address - Fax:
Practice Address - Street 1:846 BAUER ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4317
Practice Address - Country:US
Practice Address - Phone:516-360-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3180341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse