Provider Demographics
NPI:1912065509
Name:EDLUND-CHEN, CORLENE MARIE (LAP)
Entity Type:Individual
Prefix:MRS
First Name:CORLENE
Middle Name:MARIE
Last Name:EDLUND-CHEN
Suffix:
Gender:F
Credentials:LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 SE SAN SOUCI LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5764
Mailing Address - Country:US
Mailing Address - Phone:772-485-9610
Mailing Address - Fax:772-286-9478
Practice Address - Street 1:4408 S.E. COMMERCE AVENUE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:772-286-5277
Practice Address - Fax:772-286-9478
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist