Healthcare Provider Details

I. General information

NPI: 1376015594
Provider Name (Legal Business Name): RYAN MICHAEL BEDNAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 NORTHLAND DR STE 200A
MEDINA OH
44256-3440
US

IV. Provider business mailing address

6472 LAFAYETTE RD
MEDINA OH
44256-8549
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-9195
  • Fax:
Mailing address:
  • Phone: 330-819-9716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number023676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: