Individual
WANDA E EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
29000 INKSTER RD, STE 115, SOUTHFIELD, MI 48034-1097
(313) 270-4888
(313) 270-4883
Mailing address
14409 ASHTON RD, DETROIT, MI 48223-3584
(313) 837-8756
(313) 270-4883
Taxonomy
Speciality
Code
Description
License number
State
163WC1600X
Continuing Education/Staff Development Registered Nurse
4704102153
MI
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
4704102153
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704102153
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0861058
BCBS PIN
MI
01
—
693558
VALUE OPTIONS - PROVIDER CONNECT USER ID
MI
01
—
M16694
MEDICARE - PTAN
MI
Enumeration date
07/13/2005
Last updated
12/01/2020
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