Provider Demographics
NPI:1003075706
Name:BEDORE, GERALD M (APN/CNP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:M
Last Name:BEDORE
Suffix:
Gender:M
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S WOLCOTT AVE RM E-144
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3748
Mailing Address - Country:US
Mailing Address - Phone:312-996-7420
Mailing Address - Fax:312-413-8485
Practice Address - Street 1:835 S WOLCOTT AVE RM E-144
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-996-7420
Practice Address - Fax:312-413-8485
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.004416363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology