Provider Demographics
NPI:1487295119
Name:EDWARDS, ILONA ALEX JR (FNP-BC, RN)
Entity type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:ALEX
Last Name:EDWARDS
Suffix:JR
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-3258
Mailing Address - Country:US
Mailing Address - Phone:804-356-2917
Mailing Address - Fax:
Practice Address - Street 1:2018 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-3258
Practice Address - Country:US
Practice Address - Phone:804-356-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily