Provider Demographics
NPI:1356969539
Name:BEDOR, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BEDOR
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 1:2428 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2003
Mailing Address - Country:US
Mailing Address - Phone:757-575-0945
Mailing Address - Fax:
Practice Address - Street 1:2428 CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2003
Practice Address - Country:US
Practice Address - Phone:757-575-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001253311163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy