MEDICARE: ELIZABETH MARY EDLING NLC, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20171447254	OTHER		TRADE NAME

General Provider Information

NPI Number	:	1477083954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY EDLING NLC, MA

Provider Business Mailing Address
First Line	:	8321 STEADMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7058
Country	:	US
Telephone Number	:	719-888-9110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8321 STEADMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7058
Country	:	US
Telephone Number	:	719-888-9110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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