Healthcare Provider Details

I. General information

NPI: 1811887995
Provider Name (Legal Business Name): BETHANY GEDNEY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 CHESTNUT HILL DR
MIDLAND MI
48642-6208
US

IV. Provider business mailing address

3807 CHESTNUT HILL DR
MIDLAND MI
48642-6208
US

V. Phone/Fax

Practice location:
  • Phone: 515-357-7288
  • Fax: 515-357-7288
Mailing address:
  • Phone: 515-357-7288
  • Fax: 515-357-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-319138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: