Healthcare Provider Details

I. General information

NPI: 1477145043
Provider Name (Legal Business Name): CHRISTINE ELAINE BEDARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CHRISTINE ELAINE ROSS

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E CENTRAL AVE
PAOLI PA
19301-1345
US

IV. Provider business mailing address

19 E CENTRAL AVE
PAOLI PA
19301-1345
US

V. Phone/Fax

Practice location:
  • Phone: 610-640-4150
  • Fax: 610-296-9970
Mailing address:
  • Phone: 610-640-4150
  • Fax: 610-296-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN297582L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: