Provider Demographics
NPI:1184039208
Name:BEDINGFIELD, SHAD J (RN)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:J
Last Name:BEDINGFIELD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8434 CABIN PEAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2838
Mailing Address - Country:US
Mailing Address - Phone:702-544-1632
Mailing Address - Fax:
Practice Address - Street 1:8434 CABIN PEAK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2838
Practice Address - Country:US
Practice Address - Phone:702-544-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN67668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse