Provider Demographics
NPI:1518315811
Name:BEDWELL, LYNDSAY J (FNP)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:J
Last Name:BEDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNDSAY
Other - Middle Name:J
Other - Last Name:BILLINGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:505 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3352
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:309-836-2369
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041374069163W00000X
IL209014696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse