Healthcare Provider Details

I. General information

NPI: 1093915027
Provider Name (Legal Business Name): REBECCA ANN BEDARD RN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MASSACHUSETTS AVE
BOSTON MA
02118-2600
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVE
BOSTON MA
02118-2600
US

V. Phone/Fax

Practice location:
  • Phone: 617-534-4222
  • Fax:
Mailing address:
  • Phone: 617-534-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number223771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: