Provider Demographics
NPI:1336104611
Name:LEMBECK-EDENS, MICHAEL A (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:LEMBECK-EDENS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6993
Mailing Address - Country:US
Mailing Address - Phone:814-234-0666
Mailing Address - Fax:
Practice Address - Street 1:PENN STATE UNIVERSITY
Practice Address - Street 2:222 ELMORE RESEARCH WING NOLL LAB
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:814-863-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily