Provider Demographics
NPI:1679075261
Name:EDWARDS, ELIZABETH DAWN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DAWN
Other - Last Name:PARISI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:395 VALLEJO DR APT 20
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2800
Mailing Address - Country:US
Mailing Address - Phone:650-436-8986
Mailing Address - Fax:
Practice Address - Street 1:710 S BROADWAY STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5234
Practice Address - Country:US
Practice Address - Phone:925-314-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator