Healthcare Provider Details

I. General information

NPI: 1427394360
Provider Name (Legal Business Name): HEIDI CHRISTINE BEDNARCHUK ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI CHRISTINE MITTELSTADT

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MARSH ST
MANKATO MN
56001-4752
US

IV. Provider business mailing address

PO BOX 8673 1025 MARSH ST
MANKATO MN
56002-8673
US

V. Phone/Fax

Practice location:
  • Phone: 507-304-7020
  • Fax:
Mailing address:
  • Phone: 507-304-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR 173365-1
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number31
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: