Provider Demographics
NPI:1518113380
Name:BEDNAREK, REBECCA SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:BEDNAREK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUZANNE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:5344 SACANDAGA RD.
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-0190
Mailing Address - Country:US
Mailing Address - Phone:518-882-6955
Mailing Address - Fax:
Practice Address - Street 1:5344 SACANDAGA RD.
Practice Address - Street 2:
Practice Address - City:GALWAY
Practice Address - State:NY
Practice Address - Zip Code:12074
Practice Address - Country:US
Practice Address - Phone:518-882-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily