Basic Information
Provider Information
NPI: 1003001835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON
FirstName: EDITH
MiddleName: LEWIS
NamePrefix: MRS.
NameSuffix:  
Credential: R. N., B. S. N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3708 MAIN ST
Address2:  
City: BELLE CHASSE
State: LA
PostalCode: 700373002
CountryCode: US
TelephoneNumber: 5043935624
FaxNumber: 5043935633
Practice Location
Address1: 3708 MAIN ST
Address2:  
City: BELLE CHASSE
State: LA
PostalCode: 700373002
CountryCode: US
TelephoneNumber: 5043935624
FaxNumber: 5043935633
Other Information
ProviderEnumerationDate: 09/14/2007
LastUpdateDate: 09/14/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X094894LAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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