Healthcare Provider Details

I. General information

NPI: 1700650660
Provider Name (Legal Business Name): PAUL BEDNARSKI MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD STE 300
DEARBORN MI
48120-1805
US

IV. Provider business mailing address

2327 9TH ST
WYANDOTTE MI
48192-4361
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 734-306-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704314702
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704314702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: