Healthcare Provider Details

I. General information

NPI: 1588099071
Provider Name (Legal Business Name): MELISSA JEAN BEDNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29613 7 MILE RD
LIVONIA MI
48152-1909
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 734-743-2579
  • Fax: 734-743-2579
Mailing address:
  • Phone: 313-874-4806
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704268758
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: