1922360973 NPI number — DR. CARLA MARIE EDWARDS PH.D., L.AC., DIPL O

Table of content: DR. CARLA MARIE EDWARDS PH.D., L.AC., DIPL O (NPI 1922360973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922360973 NPI number — DR. CARLA MARIE EDWARDS PH.D., L.AC., DIPL O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
CARLA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., L.AC., DIPL O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922360973
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 GREENWOOD ST
Provider Second Line Business Mailing Address:
UNIT 105
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-3979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-525-1309
Provider Business Mailing Address Fax Number:
847-859-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 SHERMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-525-1309
Provider Business Practice Location Address Fax Number:
847-859-6100
Provider Enumeration Date:
06/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  198.000601 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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