Provider Demographics
NPI:1477145043
Name:BEDARD, CHRISTINE ELAINE (RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:BEDARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ELAINE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1345
Mailing Address - Country:US
Mailing Address - Phone:610-640-4150
Mailing Address - Fax:610-296-9970
Practice Address - Street 1:19 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1345
Practice Address - Country:US
Practice Address - Phone:610-640-4150
Practice Address - Fax:610-296-9970
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN297582L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse