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Individual

LISA EDWARDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5447 MAPLE LN STE A, FAYETTEVILLE, WV 25840-6872
(304) 573-6120
Mailing address
5447 MAPLE LN STE A, FAYETTEVILLE, WV 25840-6872
(304) 573-6120

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
35564
WV

Other

Enumeration date
02/16/2024
Last updated
02/16/2024
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