Healthcare Provider Details

I. General information

NPI: 1851525927
Provider Name (Legal Business Name): LYNETTE LINDA BEDFORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 NEW UTRECHT AVE
BROOKLYN NY
11219
US

IV. Provider business mailing address

619 ROGERS AVE TOP FLOOR
BROOKLYN NY
11225
US

V. Phone/Fax

Practice location:
  • Phone: 212-687-7464
  • Fax:
Mailing address:
  • Phone: 718-916-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number497603
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 337076
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number497603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: