Basic Information
| Provider Information | |||||||||
| NPI: | 1134169428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | FLOYD | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3912 BREAKING DAWN ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809251123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193915116 | ||||||||
| FaxNumber: | 7193915117 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 COCHRANE CIRRCLE | ||||||||
| Address2: | USA MEDDAC / EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267649 | ||||||||
| FaxNumber: | 7195267019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 27927 | CO | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.