Individual
MS. MYRA EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
103 ELM ST, 2ND FLOOR, WOODRUFF, WI 54568-9164
(715) 358-6650
(715) 358-6381
Mailing address
10598 BLUE LAKE RD, MINOCQUA, WI 54548-9041
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
27-146
WI
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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