Provider Demographics
NPI:1073836086
Name:BREDIN, TATIYANA
Entity Type:Individual
Prefix:
First Name:TATIYANA
Middle Name:
Last Name:BREDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-2109
Mailing Address - Country:US
Mailing Address - Phone:845-271-4000
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE LN
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-2109
Practice Address - Country:US
Practice Address - Phone:845-271-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse