Provider Demographics
NPI:1043077894
Name:EDLEMAN, MAUREEN MARGARET
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MARGARET
Last Name:EDLEMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 FIRETHORN DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1241
Mailing Address - Country:US
Mailing Address - Phone:484-524-3057
Mailing Address - Fax:
Practice Address - Street 1:622 FIRETHORN DR
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1241
Practice Address - Country:US
Practice Address - Phone:484-524-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
PAPN306215164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No174N00000XOther Service ProvidersLactation Consultant, Non-RN