Provider Demographics
NPI:1184305054
Name:BEDNAR, STACI
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 ELK ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3231
Mailing Address - Country:US
Mailing Address - Phone:402-613-0408
Mailing Address - Fax:
Practice Address - Street 1:1838 ELK ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3231
Practice Address - Country:US
Practice Address - Phone:402-613-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE96373172V00000X
NE3947315P00000X
NEREGISTRY1651310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No172V00000XOther Service ProvidersCommunity Health Worker
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities