Provider Demographics
NPI:1225849755
Name:EDWARDS BLOODSAW, TONJA LEANN (LICENSED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TONJA
Middle Name:LEANN
Last Name:EDWARDS BLOODSAW
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 BRYNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2417
Mailing Address - Country:US
Mailing Address - Phone:323-392-9878
Mailing Address - Fax:
Practice Address - Street 1:5409 BRYNHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2417
Practice Address - Country:US
Practice Address - Phone:323-392-9878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN181251164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse