Basic Information
| Provider Information | |||||||||
| NPI: | 1235702358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDMONDS | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LCGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197137000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4701 OGLETOWN STANTON RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197137000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234593 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2021 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | APP-000023230 | DE | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.