Provider Demographics
NPI:1235436833
Name:BEDARD, ANGELA S (STNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:BEDARD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 GLENDEAN AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1100
Mailing Address - Country:US
Mailing Address - Phone:937-732-2881
Mailing Address - Fax:
Practice Address - Street 1:905 GLENDEAN AVE
Practice Address - Street 2:APT. 7
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1100
Practice Address - Country:US
Practice Address - Phone:937-732-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401198890211376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH# 401198890211OtherNURSE AIDE REGISTRY