Edwards, Tia Marie

Edwards, Tia Marie is an individual health care provider with primary practice located at 1 Long Wharf Dr , New Haven CT 06511-5991. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Edwards, Tia Marie can be contacted via phone (203) 781-4600.

Contact Information

Primary practice address
1 Long Wharf Dr New Haven CT 06511-5991
Phone: (203) 781-4600
Fax: (203) 781-4624
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 033043 Connecticut

Profile Details

NPI number 1114274255
LBN Legal business name Edwards, Tia Marie
Credentials Licensed Practical Nurse (LPN)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 8th, 2012
Last updated Jan 15th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114274255 NPPES
Connecticut MEDICAID 008003745
Connecticut MEDICAID 004041000

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