Provider Demographics
NPI:1972611895
Name:BEDNAREK, NANCY M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:M
Last Name:BEDNAREK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 JOLIET RD STE 1
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3983
Mailing Address - Country:US
Mailing Address - Phone:708-352-0330
Mailing Address - Fax:708-352-8905
Practice Address - Street 1:6170 JOLIET RD STE 1
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3983
Practice Address - Country:US
Practice Address - Phone:708-352-0330
Practice Address - Fax:708-352-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46057Medicare PIN
ILK46058Medicare PIN