Healthcare Provider Details

I. General information

NPI: 1932331527
Provider Name (Legal Business Name): ERICA LYNN BEDSTED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N 1ST ST
FRESNO CA
93726-4301
US

IV. Provider business mailing address

3812 N 1ST ST
FRESNO CA
93726-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-495-3120
  • Fax:
Mailing address:
  • Phone: 559-495-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number624233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: