Provider Demographics
NPI:1801291398
Name:EDWARDS, DEANGELA (LPN)
Entity type:Individual
Prefix:MS
First Name:DEANGELA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 SAN RAFAEL PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5135
Mailing Address - Country:US
Mailing Address - Phone:314-265-1221
Mailing Address - Fax:
Practice Address - Street 1:2638 SAN RAFAEL PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5135
Practice Address - Country:US
Practice Address - Phone:314-265-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse