Individual
ALICE M EDWARDS
Active
Individual
ALICE M EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00475300
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00475300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000191
—
LA
01
—
5F600PF67
MEDICARE - PTAN
LA
Enumeration date
04/16/2007
Last updated
04/11/2024
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