Provider Demographics
NPI:1467703900
Name:BEDELL, ANDREA SUE (DTH)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUE
Last Name:BEDELL
Suffix:
Gender:F
Credentials:DTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24323 N HICKORY NUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-9603
Mailing Address - Country:US
Mailing Address - Phone:847-516-8411
Mailing Address - Fax:
Practice Address - Street 1:24323 N HICKORY NUT GROVE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-9603
Practice Address - Country:US
Practice Address - Phone:847-516-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist