Healthcare Provider Details

I. General information

NPI: 1720935976
Provider Name (Legal Business Name): BOB BEDNARZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 LANCASTER DR
MOKENA IL
60448-7833
US

IV. Provider business mailing address

10121 LANCASTER DR
MOKENA IL
60448-7833
US

V. Phone/Fax

Practice location:
  • Phone: 708-289-8881
  • Fax:
Mailing address:
  • Phone: 708-289-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041516644
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: