Healthcare Provider Details

I. General information

NPI: 1083865620
Provider Name (Legal Business Name): JENNIFER LYNN BEDNAR LRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN HANDY

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-3300
  • Fax: 701-364-8906
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number740
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: