Healthcare Provider Details

I. General information

NPI: 1477501534
Provider Name (Legal Business Name): TRACY BEDFORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROVENA MERCY MEDICAL CENTER 1325 N. HIGHLAND AVENUE
AURORA IL
60506
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-2222
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax: 630-874-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: