MEDICARE: MARISA BEDFORD CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	95000574	CA

General Provider Information

NPI Number	:	1285182162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA BEDFORD CRNA

Provider Business Mailing Address
First Line	:	2435 SAINT MORITZ DR
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95242-9602
Country	:	US
Telephone Number	:	209-639-2901
Fax Number	:

Provider Business Practice Location Address
First Line	:	2435 SAINT MORITZ DR
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95242-9602
Country	:	US
Telephone Number	:	209-639-2901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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