1659831790 NPI number — STEPHANIE BEDNAR RN

Table of content: STEPHANIE BEDNAR RN (NPI 1659831790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659831790 NPI number — STEPHANIE BEDNAR RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEDNAR
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659831790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3928 LOCH BEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-4341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-779-7427
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HAGGERTY RD STE 2160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48323-2192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-859-2457
Provider Business Practice Location Address Fax Number:
248-859-2473
Provider Enumeration Date:
03/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  4704306313 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4704306313 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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