Individual
RODRICK EDELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
309 S BLOCK AVE APT 7, FAYETTEVILLE, AR 72701-6487
(479) 502-4159
Mailing address
309 S BLOCK AVE APT 7, FAYETTEVILLE, AR 72701-6487
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51509
MHPP
AR
Enumeration date
05/10/2016
Last updated
05/10/2016
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