Provider Demographics
NPI:1851137814
Name:EDMAN, CHARLENE MARIE (RN, NP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:EDMAN
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3201
Mailing Address - Country:US
Mailing Address - Phone:925-212-4424
Mailing Address - Fax:
Practice Address - Street 1:2 KORET WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2218
Practice Address - Country:US
Practice Address - Phone:925-212-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030845363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health