Healthcare Provider Details

I. General information

NPI: 1912065509
Provider Name (Legal Business Name): CORLENE MARIE EDLUND-CHEN L.AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 S.E. COMMERCE AVENUE
STUART FL
34997
US

IV. Provider business mailing address

1431 SE SAN SOUCI LN
PORT SAINT LUCIE FL
34952-5764
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-5277
  • Fax: 772-286-9478
Mailing address:
  • Phone: 772-485-9610
  • Fax: 772-286-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: