Individual
ANDREA DENESE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12661 NS 3660, WEWOKA, OK 74884-6022
(405) 380-7751
Mailing address
12661 NS 3660, WEWOKA, OK 74884-6022
(405) 380-7751
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
06/17/2013
Last updated
06/25/2013
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