Basic Information
| Provider Information | |||||||||
| NPI: | 1952041329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDELL | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7339 W ROLSTON RD | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484519766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109557844 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1057 E COLDWATER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485051501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102573705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2022 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 4704290234 | MI | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.